Η οισοφαγική βηματοδότηση στη φαρμακευτική αντιμετώπιση υπερκοιλιακών ταχυκαρδιών

Abstract

Transesophageal electrophysiological studies are a relatively noninvasive means of characterizing supraventricular tachycardia in patients with disabling symptoms and testing electropharmacologically. The aim of the study was to perform electropharmacologic tests that consist of first inducing a clinical arrhythmia by transesophageal atrial pacing protocol and then evaluating the optimal antiarrhythmic drug therapy. Methods: 221 patients (91 Men - 130 Women, mean age 54.63+22.36 years) with disabling episodes of inducible supraventricular tachycardias were tested electropharmacologically by transesophageal atrial pacing. The results were compared with respect to the cause and mechanism of the tachycardias and the optimum antiarrhythmic drug, either after acute intravenous administration or during oral steady state. Quality of life of the patients due to relapses and disabling symptoms was estimated during the follow up period (1 year). Results: Using this technique we induced AVNRT in 168 patients (78.87%), AVRT in 37 patients (17.4%) and ectopic atrial tachycardia in 8 patients (3.76%). We then performed an antiarrhythmic drug test. We tested 326 drugs or combination of drugs that is 1.53 therapies per patient, before the results were considered positive. The overall number of tests was 502, that is 2.36 per patient. In 163 patients (76.53%) first electropharmacologic test was considered successful, but in other 50 patients (23.47%) more tests were claimed. All patients tolerated the procedure well and were discharged with the drug or combination of drugs judged effective. During follow up period 188 αζζελείο (88,26%) were symptoms free or had minor disablement. In addition, relapses of the tachycardia were decreased at 86.77% (p<0.0001) and time where patients were symptom-free increased at 49.42% (p=0.001). Besides frequency and severity of symptoms were decreased at 83.92% (p<0.001) and 80.09% (p<0.001) respectively, in comparison with the time period before the application of the method. Conclusion: Electropharmacologic testing with transesophageal pacing constitutes a very good approach for inducible supraventricular tachycardias: it permits selection of optimal long-term antiarrhythmic treatment and is well tolerated, only slightly invasive and without adverse effects