Frequency of atrial tachyarrhythmias in patients treated by cardiac resynchronization (from the Prospective, Multicenter Mona Lisa Study)
Résumé
The continuous measurement of sustained atrial tachyarrhythmia (AT) is now possible with some permanently implanted devices. Data on this subject remain controversial. The aim of this study was to evaluate the incidence of sustained AT in patients treated with cardiac resynchronization therapy using pacemakers without backup defibrillators (CRT-P), within the first year after implantation, using strict definition criteria for sustained AT and a systematic review of all high-quality electrographically recorded episodes. The Mona Lisa study was a prospective, multicenter, cohort study carried out from February 2004 to February 2006, with a 12-month follow-up period. Sustained AT was defined as an episode lasting <5 minutes; episodes were confirmed by a systematic review of electrograms in the whole study population. Of the 198 patients who underwent CRT-P device implantation and were enrolled in the study, 173 were in stable sinus rhythm at baseline and were included in the analysis (mean age 70 ± 9 years, 66% men, 91% in New York Heart Association class III, mean QRS duration 164 ± 26 ms, mean left ventricular ejection fraction 25 ± 7%). During a mean follow-up period of 9.9 ± 3.6 months, 34 patients experienced <1 episode of sustained AT, for an incidence rate of 27.5% (95% confidence interval 18.2 to 36.7). Only a history of AT was independently associated with the occurrence of sustained AT within the 12 months after CRT-P device implantation (hazard ratio 2.3, 95% confidence interval 1.2 to 4.4, p = 0.02). In conclusion, this first prospective electrogram-based evaluation of AT incidence demonstrated that 27% of patients developed <1 episode of sustained AT lasting <5 minutes in the 12 months after CRT-P device implantation. © 2010 Elsevier Inc. All rights reserved.
Mots clés
heart left ventricle ejection fraction
human
incidence
major clinical study
male
priority journal
sinus rhythm
supraventricular tachycardia
cardioversion
cohort analysis
complication
electrocardiography
heart failure
heart pacing
middle aged
multicenter study
pathophysiology
reproducibility
Tachycardia
Ectopic Atrial
time
very elderly
Aged
80 and over
Cardiac Pacing
Artificial
Cohort Studies
Electric Countershock
Electrocardiography
Ambulatory
Female
Heart Failure
Humans
Incidence
Male
Middle Aged
Pacemaker
Reproducibility of Results
Time Factors
adult
aged
article
artificial heart pacemaker
cardiac resynchronization therapy
clinical trial
electrography
female
follow up