目的:在皮下植入式心律转复除颤器(S-ICD)患者中,UNTOUCHED研究表明,在对200~250bpm的条件区和心律失常>250bpm的电击区进行编程时,不适当电击率非常低.在临床实践中采用这种编程方法的程度仍然未知。它对不适当和适当疗法的比率的影响也是如此。
结果:我们评估了56个意大利中心的1468名连续S-ICD受者的植入和随访期间的ICD编程。我们还测量了随访期间不适当和适当电击的发生。在植入时,计划条件区截止值的中位数设定为200bpm(IQR:200-220),休克区截止值设定为230bpm(IQR:210-250).随访期间,条件区截止率没有显著变化,而622例(42%)患者的休克区截止值发生了变化,中位值增加至250bpm(IQR:230-250)(P<0.001)。426名(29%)患者在植入器械后立即采用UnTOUCHED-likeprogrammingofdetectioncut-off,在714(49%,最后一次随访时P<0.001)。UnTOUCHED-likeprogrammingwasindependentlyassociatedwithlessimpossibleshakes(riskratio0.50,95CI0.25-0.98,P=0.044),对适当和无效的电击没有影响。
结论:近年来,S-ICD植入中心越来越多地编程高心律失常检测截止率,在植入新的S-ICD接受者的情况下,以及在先前存在的植入物的情况下的随访期间。这大大有助于减少临床实践中不适当电击的发生率。Rordorf:S-ICD的编程。
背景:URL:http://clinicaltrials.gov/Identifier:NCT02275637。
In subcutaneous implantable cardioverter defibrillator (S-ICD) recipients, the UNTOUCHED study demonstrated a very low inappropriate shock rate on programming a conditional zone between 200 and 250 bpm and a shock zone for arrhythmias >250 bpm. The extent to which this programming approach is adopted in clinical practice is still unknown, as is its impact on the rates of inappropriate and appropriate therapies.
We assessed ICD programming on implantation and during follow-up in a cohort of 1468 consecutive S-ICD recipients in 56 Italian centres. We also measured the occurrence of inappropriate and appropriate shocks during follow-up. On implantation, the median programmed conditional zone cut-off was set to 200 bpm (IQR: 200-220) and the shock zone cut-off was 230 bpm (IQR: 210-250). During follow-up, the conditional zone cut-off rate was not significantly changed, while the shock zone cut-off was changed in 622 (42%) patients and the median value increased to 250 bpm (IQR: 230-250) (P < 0.001). UNTOUCHED-like programming of detection cut-offs was adopted in 426 (29%) patients immediately after device implantation, and in 714 (49%, P < 0.001) at the last follow-up. UNTOUCHED-like programming was independently associated with fewer inappropriate shocks (hazard ratio 0.50, 95%CI 0.25-0.98, P = 0.044), and had no impact on appropriate and ineffective shocks.
In recent years, S-ICD implanting centres have increasingly programmed high arrhythmia detection cut-off rates, at the time of implantation in the case of new S-ICD recipients, and during follow-up in the case of pre-existing implants. This has contributed significantly to reducing the incidence of inappropriate shocks in clinical practice. Rordorf: Programming of the S-ICD.
URL: http://clinicaltrials.gov/Identifier: NCT02275637.