背景:临床实践中皮下植入式心脏复律除颤器(S-ICD)的编程研究很少,作为SMARTPass滤波器的激活状态,这是为了减少不适当的冲击。
目的:我们评估了随访期间的器械编程和连续S-ICD受者的心律失常发生率。
方法:我们分析了来自17个意大利中心的670名S-ICD患者在远程网络上随访的数据,中位时间为31个月(第25-75百分位数:16-51)。增强的SMARTPass版本,2022年10月推出,预计将降低无意停用率。
结果:在最新的远程数据传输中,条件区域截止中位数设置为210bpm(第25-75百分位数:200-220),冲击区截止值为250bpm(第25-75百分位数:240-250),586名(87%)患者启用了SMARTPass。随访期间,118例(18%)患者报告了194例自动停用事件。129例(19%)患者发生休克,在136例(20%)患者中记录到未经治疗的心律失常.当SMARTPass启用-0.12/患者年(95%CI:0.10-0.14)与0.20(95%CI:0.15-0.26)(p=0.002)时,电击率较低,未治疗的心律失常发生率为-0.12/患者年(95%CI:0.11-0.14)和0.23(95%CI:0.18-0.30)(p=.001).增强的SMARTPass版本与0.14(95%CI:0.12-0.16)(p<.001)的低停用率-0.04/患者年(95%CI:0.02-0.05)相关,治疗和未治疗的心律失常减少(发生率:0.40(95%CI:0.28-0.53)和0.40(95%CI:0.30-0.55),分别(p<.001))。
结论:中心倾向于对设备进行编程,以检测心律失常的高心室率,以减少不适当的电击发生。SMARTPass激活与较低的检测和治疗心律失常率相关。增强的SMARTPass版本似乎与较低的去活率和治疗的心律失常的进一步减少有关。
BACKGROUND: The programing of subcutaneous implantable cardioverter-defibrillators (S-ICD) in clinical practice has been little studied, as the activation status of the SMART Pass filter, which was implemented to reduce inappropriate shocks.
OBJECTIVE: We assessed device programing during follow-up and the rate of detected arrhythmias in consecutive S-ICD recipients.
METHODS: We analyzed data from 670 S-ICD patients followed on the remote network at 17 Italian centers for a median of 31 months (25th-75th percentile: 16-51). The enhanced SMART Pass version, introduced in October 2022, was expected to reduce the unintentional deactivation rate.
RESULTS: At the latest remote data transmission, the median conditional zone cut-off was set to 210 bpm (25th-75th percentile: 200-220), the shock zone cutoff was 250 bpm (25th-75th percentile: 240-250), and the SMART Pass was enabled in 586 (87%) patients. During follow-up, 194 automatic deactivation events were reported in 118 (18%) patients. Shocks were delivered in 129 (19%) patients, and untreated arrhythmias were recorded in 136 (20%) patients. The rate of shocks was lower when SMART Pass was enabled -0.12/patient-year (95% CI: 0.10-0.14) versus 0.20 (95% CI: 0.15-0.26) (p = .002), as it was the rate of untreated arrhythmias -0.12/patient-year (95% CI: 0.11-0.14) versus 0.23 (95% CI: 0.18-0.30) (p = .001). The enhanced SMART Pass version was associated with a lower rate of deactivations -0.04/patient-year (95% CI: 0.02-0.05) versus 0.14 (95% CI: 0.12-0.16) (p < .001), and with a reduction in treated and untreated arrhythmias (Incidence rate ratios: 0.40 (95% CI: 0.28-0.53) and 0.40 (95% CI: 0.30-0.55), respectively (p < .001)).
CONCLUSIONS: Centers tend to program devices to detect high ventricular rates for arrhythmia detection, to minimize inappropriate shock occurrences. SMART Pass activation is associated with lower rates of detected and treated arrhythmias. The enhanced SMART Pass version seems associated with a lower deactivation rate and with a further decrease in treated arrhythmias.