Brugada 综合征患者的 ICD 电击不当预防。
Prevention of inappropriate ICD shocks in patients with Brugada syndrome.
机构信息
1st Department of Medicine-Cardiology, University Medical Centre Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
出版信息
Clin Res Cardiol. 2010 Jan;99(1):37-44. doi: 10.1007/s00392-009-0075-4. Epub 2009 Sep 16.
BACKGROUND
In Brugada syndrome implantable cardioverter defibrillator (ICD) therapy is associated with a high rate of inappropriate therapies, mainly due to supraventricular tachyarrhythmias (SVT) (2.7-14.1%/year). Aim of the present study was to evaluate a single ventricular fibrillation (VF) detection zone with a high cut-off rate with respect to prevention of inappropriate ICD shock due to SVT and safety of this programming.
METHODS
Sixty-one consecutive patients (mean age 42.6 +/- 12.9 years; 41 males) diagnosed with Brugada syndrome and implanted with an ICD were included. ICDs were prospectively programmed with a single VF detection zone and a cut-off rate of 222 beats/minute (bpm). A maximum of six shocks with the maximal shock energy were programmed. The minimal follow-up was 1 year.
RESULTS
During a follow-up of 47.6 +/- 23.1 months seven patients (2.91%/year) received appropriate ICD shocks. No patient suffered from syncope or died. Five patients (2.07%/year) received inappropriate ICD shocks: four patients due to T-wave oversensing and only one patient (0.4%/year) due to SVT (atrial fibrillation with a ventricular rate of >222 bpm).
CONCLUSIONS
Programming of a single, high-rate VF zone in patients with Brugada syndrome and an implanted defibrillator is safe. Such programming may be associated with reduced inappropriate defibrillator discharges. A single detection zone with a high VF cut-off rate can be recommended in patients with Brugada syndrome.
背景
在 Brugada 综合征中，植入式心脏复律除颤器（ICD）治疗与较高的不适当治疗率相关，主要是由于室上性心动过速（SVT）（2.7-14.1%/年）。本研究的目的是评估具有较高截止率的单一心室颤动（VF）检测区，以预防因 SVT 引起的不适当 ICD 电击，并评估这种编程的安全性。
方法
连续纳入 61 例 Brugada 综合征诊断并植入 ICD 的患者（平均年龄 42.6 +/- 12.9 岁；41 名男性）。前瞻性地将 ICD 编程为具有单一 VF 检测区和 222 次/分钟（bpm）的截止率。最多编程 6 次最大电击能量的电击。最小随访时间为 1 年。
结果
在 47.6 +/- 23.1 个月的随访中，有 7 例患者（2.91%/年）接受了适当的 ICD 电击。无患者发生晕厥或死亡。5 例患者（2.07%/年）发生了不适当的 ICD 电击：4 例患者由于 T 波过感知，仅 1 例患者（0.4%/年）由于 SVT（心室率>222 bpm 的心房颤动）。
结论
在 Brugada 综合征患者和植入式除颤器中编程单一、高心率 VF 区是安全的。这种编程可能与减少不适当的除颤器放电有关。建议在 Brugada 综合征患者中使用具有较高 VF 截止率的单一检测区。
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