Publication: Efecto de la estimulación con respuesta en frecuencia en la incidencia de arritmias auriculares en los pacientes portadores de desfibrilador automático implantable
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2017-02-09
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Universidad Complutense de Madrid
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Abstract
"INTRODUCCIÓN Y OBJETIVO" Los modos de estimulación mediante respuesta en frecuencia (ERF) fueron desarrollados en los dispositivos para poder adaptar la frecuencia cardiaca al aumento de las necesidades metabólicas. Su rendimiento ha sido estudiado fundamentalmente en pacientes portadores marcapasos, donde han mostrado mejorar la capacidad funcional cuando existe datos de insuficiencia cronotrópica, sin aportar un beneficio claro en el resto de los casos. La ERF auricular se ha incorporado en los desfibriladores automáticos implantables (DAI) bicamerales y tricamerales actuales a pesar de no existir estudios ni recomendaciones sobre su uso en este tipo de pacientes. Se desconocen las consecuencias de la estimulación rápida y continuada a largo plazo de la aurícula producida por la ERF auricular en los pacientes con DAI. El objetivo de este estudio es determinar una eventual asociación entre la ERF auricular y el desarrollo de arritmias auriculares en pacientes con DAI. "MÉTODOS" Se trata de un estudio multicéntrico a nivel nacional con un diseño observacional prospectivo y retrospectivo de cohortes, dentro del marco de investigación del registro Umbrella (Incidencia de arritmias en la población española con un DAI Medtronic). Se incluyeron pacientes portadores de DAI bicameral y tricameral integrados en un sistema de seguimiento remoto, excluyendo aquellos que estaban en FA crónica y/o funcionando en modo VVI. Se calculo el riesgo de aparición de episodios de TA/FA de duración >5 minutos y >23 horas mediante regresión logística binaria. Posteriormente se construyo un modelo multivariable utilizando las variables con valor de p <0,20 en el análisis univariable. Se comparó el número de episodios de taquicardia auricular (TA) y/o FA almacenados en el seguimiento remoto y la carga de TA/FA mediante la prueba U de Mann-‐Whitney. Se analizó la supervivencia libre de episodios de TA/FA de duración >5 minutos y >23 horas mediante curvas de Kaplan-‐Meier, utilizando el test de log-‐rank para la comparación de los distintos grupos...
"BACKGROUND AND AIM" Atrial rate-‐responsive pacing modes were developed to automatically adapt the heart rate to metabolic demands. Their performance has been studied mainly in pacemaker recipients, proving an improvement in functional status in the case of chronotropic incompetence, but without providing any clear benefit in the rest of the cases. Atrial rate-‐responsive has been incorporated to current dual and triple-‐ chamber implantable cardioverter-‐defibrillators (ICD) despite the absence of studies or recommendations regarding its use in these patients. Consequences of fast and continuous long-‐term atrial pacing provided by rate-‐responsive pacing modes in ICD patients are unknown. The aim of this study is to evaluate a potential relationship between atrial rate-‐responsive pacing and the occurrence of atrial arrhythmias in ICD recipients. "METHODS" This is a nationwide multicenter prospective and retrospective cohort observational study, included in the framework of the Umbrella registry (Incidence of arrhythmias in the Spanish population with a Medtronic ICD). Dual-‐chamber and triple-‐chamber ICD patients followed by remote monitoring where included and those with permanent atrial fibrillation (AF) or VVI pacing mode were excluded. The number and duration of atrial tachycardia (AT)/AF episodes were assessed by remote monitoring. The risk of development of AT/AF episodes > 5 minutes and > 23 hours was calculated by binary logistic regression. Then, a multivariate model was created using the variables with a p value <0.20 in the univariate model. The number of AT/AF stored episodes and AT/AF burden during follow-‐up were compared with the Mann-‐Whitney´s U test. AT/AF episodes >5 minutes and > 23 hours free survival were analyzed by Kaplan-‐Meier curves and compared by the log-‐rank test...
"BACKGROUND AND AIM" Atrial rate-‐responsive pacing modes were developed to automatically adapt the heart rate to metabolic demands. Their performance has been studied mainly in pacemaker recipients, proving an improvement in functional status in the case of chronotropic incompetence, but without providing any clear benefit in the rest of the cases. Atrial rate-‐responsive has been incorporated to current dual and triple-‐ chamber implantable cardioverter-‐defibrillators (ICD) despite the absence of studies or recommendations regarding its use in these patients. Consequences of fast and continuous long-‐term atrial pacing provided by rate-‐responsive pacing modes in ICD patients are unknown. The aim of this study is to evaluate a potential relationship between atrial rate-‐responsive pacing and the occurrence of atrial arrhythmias in ICD recipients. "METHODS" This is a nationwide multicenter prospective and retrospective cohort observational study, included in the framework of the Umbrella registry (Incidence of arrhythmias in the Spanish population with a Medtronic ICD). Dual-‐chamber and triple-‐chamber ICD patients followed by remote monitoring where included and those with permanent atrial fibrillation (AF) or VVI pacing mode were excluded. The number and duration of atrial tachycardia (AT)/AF episodes were assessed by remote monitoring. The risk of development of AT/AF episodes > 5 minutes and > 23 hours was calculated by binary logistic regression. Then, a multivariate model was created using the variables with a p value <0.20 in the univariate model. The number of AT/AF stored episodes and AT/AF burden during follow-‐up were compared with the Mann-‐Whitney´s U test. AT/AF episodes >5 minutes and > 23 hours free survival were analyzed by Kaplan-‐Meier curves and compared by the log-‐rank test...
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Tesis inédita de la Universidad Complutense de Madrid, Facultad de Medicina, Departamento de Medicina, leída el 29-06-2015