背景:植入式心律转复除颤器(ICD)需要可靠地检测室性心动过速(VT)和心室纤颤(VF),同时避免T波过度感知(TWOS),这与不适当治疗的风险有关。TWOS与血管内ICD的发生率似乎在制造商之间有所不同。
目的:我们旨在用当代美敦力和波士顿科学ICD评估TWOS的发生率和临床后果。
方法:包括连续植入最近的Medtronic或BostonScientificICD并在三个法国中心进行远程监测的患者。所有发送的标为VF的电描记图,VT,非持续性室性心动过速(NSVT),或心室过度感知(Medtronic)进行TWOS筛查。
结果:在波士顿科学ICD的674名患者的7589次传播发作中,我们没有发现一例TWOS.在1733例MedtronicICD患者的16,790例传播发作中,我们确定了60例(3.4%)至少有一次TWOS发作.在46名患者中,TWOS是间歇性的(NSVT发作)。其余14名患者,TWOS导致60持续发作(已完成计数器)。其中12名患者没有接受不适当的治疗,因为没有对治疗进行编程(在监测区,11发作)或因为治疗被形态鉴别器抑制(小波,19集)或通过反TWOS算法(26集)。两名患者因TWOS接受了不适当的治疗(美敦力ICD患者的0.1%)。
结论:回顾了2407例血管内ICD患者的24,379次传播发作,我们没有发现波士顿科学公司的TWOS病例,而TWOS在Medtronic设备中并不少见。然而,使用美敦力ICD的不当治疗的风险非常低(0.1%),因为这种现象通常是间歇性的,形态鉴别器,和反TWOS算法。
BACKGROUND: Implantable cardioverter-defibrillators (ICDs) need to reliably detect ventricular tachycardia (VT) and ventricular fibrillation (VF) while avoiding T-wave oversensing (TWOS), which is associated with a risk of inappropriate therapies. The incidence of TWOS with endovascular ICDs appears to differ between manufacturers.
OBJECTIVE: We aimed to evaluate the incidence and clinical consequences of TWOS with contemporary Medtronic and Boston Scientific ICDs.
METHODS: Consecutive patients implanted with a recent Medtronic or Boston Scientific ICD and remotely monitored at three French centers were included. All transmitted EGMs labelled as VF, VT, non-sustained VT (NSVT), or ventricular oversensing (Medtronic) were screened for TWOS.
RESULTS: Among 7589 transmitted episodes from 674 patients with a Boston Scientific ICD, we did not identify a single case of TWOS. Among 16,790 transmitted episodes from 1733 patients with a Medtronic ICD, we identified 60 patients (3.4%) with at least one episode of TWOS. In 46 patients, TWOS was intermittent (NSVT episodes). In the remaining 14 patients, TWOS resulted in 60 sustained episodes (completed counters). No inappropriate therapies were delivered in 12 of these patients because no therapies were programmed (in monitor zones, 11 episodes) or because therapies were inhibited by the morphology discriminator (Wavelet, 19 episodes) or by the anti-TWOS algorithm (26 episodes). Two patients received inappropriate therapies due to TWOS (0.1% of patients with Medtronic ICDs).
CONCLUSIONS: On review of 24,379 transmitted episodes from 2407 patients with endovascular ICDs, we found no case of TWOS with Boston Scientific devices, whereas TWOS was not uncommon with Medtronic devices. However, the risk of inappropriate therapy with Medtronic ICDs was very low (0.1%) due to the often intermittent nature of this phenomenon, the morphology discriminator, and the anti-TWOS algorithm.