Kouakam Claude, Kacet Salem, Hazard Jean-René, Ferraci Ange, Mansour Hassan, Defaye Pascal, Davy Jean-Marc, Lambiez Marie
Department of Cardiac Pacing and Electrophysiology, Lille University Hospital, France.
Europace. 2004 Jan;6(1):32-42. doi: 10.1016/j.eupc.2003.09.007.
Inappropriate therapies remain a major problem in patients with implantable cardioverter defibrillators (ICDs). Decreasing the proportion of inappropriate therapies is a major objective. With the addition of atrial detection and advanced algorithms, dual-chamber ICDs are designed to offer better discrimination of ventricular (VT) and supraventricular (SVT) arrhythmias. The present multicentre, open study aimed to evaluate the performance of a dual-chamber detection algorithm, the Atrial View algorithm, incorporated in a dual-chamber ICD, the Ventak AV (Guidant Inc., St. Paul, Minnesota, USA).
Fifty-one patients (45 males, 62+/-11 years, ejection fraction 42+/-15%) with standard indications received a Ventak AV ICD which analyzes, within the VT zone RR stability, tachycardia onset, atrial rate and AV relationship. Predischarge enhanced-detection algorithms were prospectively programmed: stability 24 ms, onset 9%, atrial fibrillation threshold 200 beats/min, and Vrate>Arate. An additional sustained rate duration criterion was programmed at least at 30 s. ICDs were interrogated every 3 months or when patients received shocks. A blinded review of electrograms for arrhythmia diagnosis and appropriateness of therapy was performed by 2 experts. Over the follow-up period (12+/-3.6 months), a total of 400 tachycardia episodes was recorded within the VT zone. After the review of stored electrograms, 237 (59%) true positive, 143 (36%) true negative, 17 (4%) false positive and 3 (1%) false negative episodes were diagnosed. Considering the 3 VTs incorrectly detected by the detection algorithms, therapy was delivered in 2 cases after sustained rate duration and 1 VT reverted spontaneously. Inappropriate therapy occurred in 17 cases. All but 1 were related to SVT with 1:1 atrioventricular relationship. Finally, on a per episode basis, the detection algorithm sensitivity was 99% and specificity was 89%.
Programming of detection criteria based on stability, onset, atrial fibrillation rate threshold and Vrate>Arate allows a 99% sensitivity and an 89% specificity in Guidant ICDs. Discrimination of SVT with 1:1 atrioventricular relationship, however, remains a challenge for which new algorithms have to be designed.
在植入式心脏复律除颤器（ICD）患者中，不适当治疗仍然是一个主要问题。降低不适当治疗的比例是一个主要目标。随着心房检测和先进算法的加入，双腔ICD旨在更好地区分室性（VT）和室上性（SVT）心律失常。本多中心、开放性研究旨在评估双腔检测算法——心房视图算法，该算法应用于双腔ICD Ventak AV（美国明尼苏达州圣保罗市Guidant公司）。
51例（45例男性，年龄62±11岁，射血分数42±15%）有标准适应证的患者接受了Ventak AV ICD，该ICD在VT区内分析RR稳定性、心动过速发作、心房率和房室关系。出院前前瞻性地设置了增强检测算法：稳定性24毫秒，发作9%，房颤阈值200次/分钟，以及心室率>心房率。另外至少设置了30秒的持续心率持续时间标准。每3个月或患者接受电击时对ICD进行询问。由2名专家对心电图进行盲法审查以诊断心律失常并判断治疗的适当性。在随访期（12±3.6个月）内，VT区内共记录到400次心动过速发作。在审查存储的心电图后诊断出237次（59%）真阳性、143次（36%）真阴性、17次（4%）假阳性和3次（1%）假阴性发作。考虑到检测算法错误检测到的3次VT，2例在持续心率持续时间后进行了治疗，1次VT自发恢复。发生了17例不适当治疗。除1例外，所有不适当治疗均与1:1房室关系的SVT有关。最后，基于每次发作，检测算法的敏感性为99%，特异性为89%。
基于稳定性、发作、房颤率阈值和心室率>心房率设置检测标准，在Guidant ICD中可实现99%的敏感性和89%的特异性。然而，区分1:1房室关系的SVT仍然是一个挑战，为此必须设计新的算法。
