Duncan Edward, Thomas Glyn, Johns Neville, Pfeffer Cameron, Appanna Gautham, Shah Nirav, Hunter Ross, Finlay Malcolm, Schilling Richard J, Sporton Simon
Department of Cardiology, Barts and the London NHS Trust, London, UK.
Pacing Clin Electrophysiol. 2010 Nov;33(11):1353-8. doi: 10.1111/j.1540-8159.2010.02859.x. Epub 2010 Aug 18.
We reviewed outcomes in our primary prevention implantable cardioverter defibrillator (ICD) population according to whether the device was programmed with a single ventricular fibrillation (VF) zone or with two zones including a ventricular tachycardia (VT) zone in addition to a VF zone.
This retrospective study examined 137 patients with primary prevention ICDs implanted at our institution between 2004 and 2006. Device programming and events during follow-up were reviewed. Outcomes included all-cause mortality, time to first shock, and incidence of shocks.
Eighty-seven ICDs were programmed with a single VF zone (mean >193 ± 1 beats per minute [bpm]) comprising shocks only. Fifty ICDs had two zones (mean VT zone >171 ± 2 bpm; VF zone >205 ± 2 bpm), comprising antitachycardia pacing (100%), shocks (96%), and supraventricular (SVT) discriminators (98%) . Discriminator "time out" functions were disabled. Mean follow-up was 30 ± 0.5 months and similar in both groups. All-cause mortality (12.6% and 12.0%) and time to first shock were similar. However, the two-zone group received more shocks (32.0% vs 13.8% P = 0.01). Five of 16 shocks in these patients were inappropriate for SVT rhythms. The single-zone group had no inappropriate shocks for SVTs. Eighteen of 21 appropriate shocks were for ventricular arrhythmias at rates >200 bpm (three VF, 15 VT). This suggests that primary prevention ICD patients infrequently suffer ventricular arrhythmias at rates <200 bpm and that ATP may play a role in terminating rapid VTs.
Patients with two-zone devices received more shocks without any mortality benefit.
我们根据植入式心律转复除颤器（ICD）是设置为单个室颤（VF）区还是设置为两个区（包括除VF区外还有室性心动过速（VT）区），对我们的一级预防ICD人群的结局进行了回顾。
这项回顾性研究检查了2004年至2006年期间在我们机构植入一级预防ICD的137例患者。回顾了设备设置和随访期间的事件。结局包括全因死亡率、首次电击时间和电击发生率。
87台ICD设置为单个VF区（平均>193±1次/分钟[bpm]），仅包括电击。50台ICD有两个区（平均VT区>171±2 bpm；VF区>205±2 bpm），包括抗心动过速起搏（100%）、电击（96%）和室上性（SVT）鉴别器（98%）。鉴别器“超时”功能被禁用。平均随访时间为30±0.5个月，两组相似。全因死亡率（12.6%和12.0%）和首次电击时间相似。然而，两区组接受的电击更多（32.0%对13.8%，P = 0.01）。这些患者中16次电击中有5次对于SVT节律是不适当的。单区组没有针对SVT的不适当电击。21次适当电击中有18次是针对心率>200 bpm的室性心律失常（3次VF，15次VT）。这表明一级预防ICD患者很少发生心率<200 bpm的室性心律失常，并且抗心动过速起搏可能在终止快速VT中起作用。
使用两区设备的患者接受了更多电击，但没有任何死亡率益处。
