Srivatsa Uma N, Hoppe Bobbi L, Narayan Sanjiv, Feld Gregory K, Birgersdotter-Green Ulrika
UCSD Medical Center, and the Veterans Administration Medical Center, San Diego, CA, USA.
Indian Pacing Electrophysiol J. 2007 Apr 1;7(2):77-84.
The incidence of inappropriate therapy from implantable cardioverter defibrillators (ICDs) has been reduced by programming ventricular arrhythmia discriminators (VAD) on at the time of implant.
To determine which VAD is most effective in preventing inappropriate therapy.
Dual chamber ICD (n=48) or cardiac resynchronization therapy defibrillator (CRT-D) (n=55) implantation was performed in 103 patients (M=94, F=9). Patients were followed prospectively for therapy events (shock or anti-tachycardia pacing) for a mean 362+/-289 days. Events were correlated with clinical characteristics and VAD programming. Of the 103 pts followed, 11 received inappropriate therapy (IT), 15 received appropriate therapy (AT), and 77 received no therapy (NT). In the AT and IT groups, a total of 207 events (ATP=171, shock=36) were observed. A total of sixty-four electrograms (EGMs) were analyzed. Programming VADs "ON" versus "OFF" reduced the incidence of IT events compared to those receiving AT or NT events (p<.01), with a trend in fewer patients receiving IT (31.3% "ON" vs 55.6% "OFF", p = 0.131). Programming atrial fibrillation (AF) detection ON resulted in fewer patients receiving IT compared to those receiving AT or NT (3.6% vs 19%, p<.05). Furthermore, programming AF or AFL algorithms "ON", resulted in overall fewer episodes of IT therapy (p<.01).
AF or AFL discriminators significantly reduced the incidence of IT, and were predominantly responsible for the benefits from VAD programming observed in this study. Activating these features as part of routine ICD or CRT-D programming may provide a simple and effective alternative to the use of more complex and multiple VAD strategies.
通过在植入时对室性心律失常鉴别器（VAD）进行编程，植入式心脏复律除颤器（ICD）不适当治疗的发生率已有所降低。
确定哪种VAD在预防不适当治疗方面最有效。
对103例患者（男性94例，女性9例）进行了双腔ICD（n = 48）或心脏再同步治疗除颤器（CRT-D）（n = 55）植入。对患者进行前瞻性随访，观察治疗事件（电击或抗心动过速起搏），平均随访时间为362±289天。将事件与临床特征和VAD编程相关联。在随访的103例患者中，11例接受了不适当治疗（IT），15例接受了适当治疗（AT），77例未接受治疗（NT）。在AT组和IT组中，共观察到207次事件（ATP = 171次，电击 = 36次）。共分析了64份心电图（EGM）。与接受AT或NT事件的患者相比，将VAD编程为“开启”与“关闭”可降低IT事件的发生率（p <.01），接受IT治疗的患者数量有减少趋势（“开启”组为31.3%，“关闭”组为55.6%，p = 0.131）。与接受AT或NT治疗的患者相比，将房颤（AF）检测编程为开启可使接受IT治疗的患者数量减少（3.6%对19%，p <.05）。此外，将AF或AFL算法编程为“开启”可使IT治疗的发作总数减少（p <.01）。
AF或AFL鉴别器显著降低了IT的发生率，并且在本研究中观察到的VAD编程带来的益处主要归因于它们。作为常规ICD或CRT-D编程的一部分激活这些功能，可能为使用更复杂和多种VAD策略提供一种简单有效的替代方法。
