Abstract：
This study sought to evaluate the effects of programming a long detection in single-chamber (VVI) implantable cardioverter-defibrillators (ICDs) in the multicenter prospective ADVANCE III (Avoid DeliVering TherApies for Non-sustained Arrhythmias in ICD PatiEnts III) trial.
Programming strategies may reduce unnecessary ICD shocks and their adverse effects but to date have been described only for dual-chamber ICDs.
A total of 545 subjects (85% male; atrial fibrillation 25%, left ventricular ejection fraction 31%, ischemic etiology 68%, secondary prevention indications 32%) receiving a VVI ICD were randomized to long detection (30 of 40 intervals) or standard programming (18 of 24 intervals) based on device type, atrial fibrillation history, and indication. In both arms, antitachycardia pacing (ATP) therapy during charging was programmed for episodes with cycle length 320 to 200 ms and shock only for cycle length <200 ms. Wavelet and stability functions enabled. Therapies delivered were compared using a negative binomial regression model.
A total of 267 patients were randomized to long detection and 278 to the control group. Median follow-up was 12 months. One hundred twelve therapies (shocks and ATP) occurred in the long detection arm versus 257 in the control arm, for a 48% reduction with 30 of 40 intervals (95% confidence interval [CI]: 0.36 to 0.76; p = 0.002). In the long detection arm, overall shocks were reduced by 40% compared to the control arm (48 vs. 24; 95% CI: 0.38 to 0.94; p = 0.026) and appropriate shocks by 51% (34 vs. 74; 95% CI: 0.26 to 0.94; p = 0.033). Syncopal events did not differ between arms, but survival improved in the long detection arm.
Among patients implanted with a VVI ICD, programming with the long detection interval significantly reduced appropriate therapies, shocks, and all-cause mortality. (Avoid DeliVering TherApies for Non-sustained Arrhythmias in ICD PatiEnts III [ADVANCEIII]; NCT00617175).
Programming strategies may reduce unnecessary ICD shocks and their adverse effects but to date have been described only for dual-chamber ICDs.
A total of 545 subjects (85% male; atrial fibrillation 25%, left ventricular ejection fraction 31%, ischemic etiology 68%, secondary prevention indications 32%) receiving a VVI ICD were randomized to long detection (30 of 40 intervals) or standard programming (18 of 24 intervals) based on device type, atrial fibrillation history, and indication. In both arms, antitachycardia pacing (ATP) therapy during charging was programmed for episodes with cycle length 320 to 200 ms and shock only for cycle length <200 ms. Wavelet and stability functions enabled. Therapies delivered were compared using a negative binomial regression model.
A total of 267 patients were randomized to long detection and 278 to the control group. Median follow-up was 12 months. One hundred twelve therapies (shocks and ATP) occurred in the long detection arm versus 257 in the control arm, for a 48% reduction with 30 of 40 intervals (95% confidence interval [CI]: 0.36 to 0.76; p = 0.002). In the long detection arm, overall shocks were reduced by 40% compared to the control arm (48 vs. 24; 95% CI: 0.38 to 0.94; p = 0.026) and appropriate shocks by 51% (34 vs. 74; 95% CI: 0.26 to 0.94; p = 0.033). Syncopal events did not differ between arms, but survival improved in the long detection arm.
Among patients implanted with a VVI ICD, programming with the long detection interval significantly reduced appropriate therapies, shocks, and all-cause mortality. (Avoid DeliVering TherApies for Non-sustained Arrhythmias in ICD PatiEnts III [ADVANCEIII]; NCT00617175).
摘要：
这项研究旨在评估在多中心前瞻性ADVANCEIII（避免在ICDPatientsIII中提供非持续性心律失常的Therapies）试验中对单腔（VVI）植入式心脏复律除颤器（ICD）进行长时间检测编程的效果。
编程策略可以减少不必要的ICD冲击及其不利影响，但迄今为止仅针对双腔ICD进行了描述。
共有545名受试者（85%为男性；心房颤动25%，左心室射血分数31%,缺血性病因68%，32％）接受VVIICD的二级预防适应症根据设备类型随机分为长期检测（40个间隔中的30个）或标准程序（24个间隔中的18个），心房颤动病史,和指示。在双臂中，充电期间的抗心动过速起搏(ATP)治疗被编程为周期长度为320~200ms的发作和仅周期长度<200ms的电击.小波函数和稳定性函数启用。使用负二项回归模型比较所提供的治疗。
共有267名患者被随机分配到长期检测组，278名患者被随机分配到对照组。中位随访时间为12个月。一百一十二种疗法（电击和ATP）发生在长检测臂中，而在控制臂中发生257种。在40个间隔中的30个间隔（95％置信区间[CI]：0.36至0.76；p=0.002）减少48％。在长长的检测臂中，与控制臂相比，总体电击减少了40%(48vs.24；95%CI：0.38至0.94；p=0.026），适当冲击为51%（34与74；95%CI：0.26至0.94；p=0.033)。军种之间的晕厥事件没有区别，但是长检测臂的存活率提高了。
在植入VVIICD的患者中，长检测间隔的编程显着减少了适当的治疗，冲击,和全因死亡率。（避免在ICD患者III[ADVANCEIII]中提供非持续性心律失常的温度计；NCT00617175）。
编程策略可以减少不必要的ICD冲击及其不利影响，但迄今为止仅针对双腔ICD进行了描述。
共有545名受试者（85%为男性；心房颤动25%，左心室射血分数31%,缺血性病因68%，32％）接受VVIICD的二级预防适应症根据设备类型随机分为长期检测（40个间隔中的30个）或标准程序（24个间隔中的18个），心房颤动病史,和指示。在双臂中，充电期间的抗心动过速起搏(ATP)治疗被编程为周期长度为320~200ms的发作和仅周期长度<200ms的电击.小波函数和稳定性函数启用。使用负二项回归模型比较所提供的治疗。
共有267名患者被随机分配到长期检测组，278名患者被随机分配到对照组。中位随访时间为12个月。一百一十二种疗法（电击和ATP）发生在长检测臂中，而在控制臂中发生257种。在40个间隔中的30个间隔（95％置信区间[CI]：0.36至0.76；p=0.002）减少48％。在长长的检测臂中，与控制臂相比，总体电击减少了40%(48vs.24；95%CI：0.38至0.94；p=0.026），适当冲击为51%（34与74；95%CI：0.26至0.94；p=0.033)。军种之间的晕厥事件没有区别，但是长检测臂的存活率提高了。
在植入VVIICD的患者中，长检测间隔的编程显着减少了适当的治疗，冲击,和全因死亡率。（避免在ICD患者III[ADVANCEIII]中提供非持续性心律失常的温度计；NCT00617175）。
