Mount Sinai Medical Center, New York, New York 10029, USA.
Heart Rhythm. 2012 Jan;9(1):24-31. doi: 10.1016/j.hrthm.2011.08.005. Epub 2011 Aug 9.
The relationship between shocks, device programming, and atrial fibrillation (AF) with a rapid ventricular rate (AF + RVR) using continuous daily monitoring has not been studied in large number of patients with implantable cardioverter-defibrillators (ICDs).
The aim of this analysis was to determine the impact of ICD programming and ventricular rate control during AF on ICD shocks.
An observational cohort analysis was performed with dual-chamber ICD and cardiac resynchronization therapy-defibrillator devices. The primary endpoint was spontaneous all-cause shocked episodes per 100 patient-years. Shock reduction programming strategies were entered into a multivariable model including slowest ventricular tachycardia/ventricular fibrillation (VT/VF) detection threshold, number of intervals to detect VF (NID), supraventricular tachycardia (SVT) discriminators ON, antitachycardia pacing (ATP) ON for fast VTs (FVTs) and AF + RVR (AF ≥1 hour for ≥1 day with average ≥110 beats per minute). We also characterized the predictive ability of AF + RVR to identify patients at risk of subsequent shocks.
There were 106,513 patients at 2858 institutions, with 2.5 ± 1.4 years of follow-up, 75% being male, age 67 ± 12 years, 59% with dual-chamber ICDs, and 11% with AF + RVR. A total of 22,062 patients (21%) received 82,396 shocks. After adjusting for all variables, AF + RVR, slower VT/VF detection threshold, and shorter VF NID were found to be associated with more shocks (P < .05 for all). Continuous monitoring of AF + RVR identified patients at up to 5-fold increased risk of shocks.
Faster VT/VF detection thresholds, longer detection durations, use of SVT discriminators, and delivery of ATP reduces all-cause ICD shocks. Continuous monitoring of AF + RVR identifies patients at the highest risk of future ICD shocks.
使用连续日常监测，在大量植入式心脏复律除颤器（ICD）患者中，尚未研究电击、设备程控与快速室性心动过速（AF + RVR）之间的关系。
本分析旨在确定 ICD 程控和 AF 期间的心室率控制对 ICD 电击的影响。
对使用双腔 ICD 和心脏再同步治疗除颤器的患者进行了观察性队列分析。主要终点是每 100 患者年的自发性全因电击发作次数。电击减少程控策略被纳入多变量模型，包括最慢的室性心动过速/室颤（VT/VF）检测阈值、检测 VT 所需的间隔数（NID）、窦性心动过速（SVT）鉴别器开启、快速 VT（FVT）和 AF + RVR（AF ≥ 1 小时，≥ 1 天，平均 ≥ 110 次/分钟）的 ATP 开启。我们还描述了 AF + RVR 识别随后电击风险患者的预测能力。
共有 2858 家机构的 106513 名患者接受了 2.5±1.4 年的随访，75%为男性，年龄 67±12 岁，59%为双腔 ICD，11%为 AF + RVR。共有 22062 名患者（21%）接受了 82396 次电击。调整所有变量后，发现 AF + RVR、较慢的 VT/VF 检测阈值和较短的 VF NID 与电击次数增加相关（均<0.05）。持续监测 AF + RVR 可识别出电击风险增加 5 倍的患者。
更快的 VT/VF 检测阈值、更长的检测持续时间、SVT 鉴别器的使用和 ATP 的输送可减少 ICD 全因电击。连续监测 AF + RVR 可识别出未来 ICD 电击风险最高的患者。
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