Weber M, Böcker D, Bänsch D, Brunn J, Castrucci M, Gradaus R, Breithardt G, Block M
Department of Cardiology and Angiology and Institute for Arteriosclerosis Research, Hospital of the Westfälische Wilhelms-University, Münster, Germany.
J Cardiovasc Electrophysiol. 1999 Feb;10(2):145-53. doi: 10.1111/j.1540-8167.1999.tb00655.x.
Inappropriate therapies are the most frequent adverse event in patients with implantable cardioverter defibrillators (ICDs). Most ICDs offer a stability criterion to discriminate ventricular tachycardia (VT) from atrial fibrillation and an onset criterion to discriminate VT from sinus tachycardia. The efficacy and safety of these criteria, if used immediately after implantation, is unknown.
In a case control study, 87 patients in whom stability and onset criteria had been activated immediately after ICD implantation were matched to 87 patients in whom these criteria had not been activated. The groups were matched for known predictors of inappropriate therapies. With stability and onset criteria off, 24 patients (28%) received inappropriate therapies due to atrial fibrillation (n = 14) or sinus tachycardia (n = 11); with stability and onset on, only 11 patients (13%) were treated by the ICD due to atrial fibrillation (n = 5) or sinus tachycardia (n = 7) (log rank: P = 0.029). Five patients suffered inappropriate therapies despite the fact that onset (n = 4) or stability (n = 1) criteria were not fulfilled once tachycardias continued for a prespecified duration. Only one patient experienced a failure to detect VT due to the onset criterion; none because of stability.
The immediate use of stability and onset criteria after ICD implantation reduces inappropriate therapies due to atrial fibrillation and sinus tachycardia. Because of the potential for underdetection of VT, this approach should be limited to tachycardia rates hemodynamically tolerated by the patient.
不适当治疗是植入式心脏复律除颤器（ICD）患者中最常见的不良事件。大多数ICD提供了一个稳定性标准来区分室性心动过速（VT）与心房颤动，以及一个起始标准来区分VT与窦性心动过速。这些标准在植入后立即使用时的疗效和安全性尚不清楚。
在一项病例对照研究中，将87例ICD植入后立即激活稳定性和起始标准的患者与87例未激活这些标准的患者进行匹配。两组在已知的不适当治疗预测因素方面进行了匹配。在稳定性和起始标准关闭的情况下，24例患者（28%）因心房颤动（n = 14）或窦性心动过速（n = 11）接受了不适当治疗；在稳定性和起始标准开启的情况下，只有11例患者（13%）因心房颤动（n = 5）或窦性心动过速（n = 7）接受了ICD治疗（对数秩检验：P = 0.029）。尽管心动过速持续了预定时间后起始标准（n = 4）或稳定性标准（n = 1）未满足，但仍有5例患者接受了不适当治疗。只有1例患者因起始标准未能检测到VT；因稳定性标准未出现这种情况。
ICD植入后立即使用稳定性和起始标准可减少因心房颤动和窦性心动过速导致的不适当治疗。由于存在VT检测不足的可能性，这种方法应限于患者血流动力学能够耐受的心动过速速率。
