Department of Cardiology, King's College Hospital NHS Foundation Trust, London, United Kingdom.
Department of Cardiology, King's College Hospital NHS Foundation Trust, London, United Kingdom.
Heart Rhythm. 2014 May;11(5):828-35. doi: 10.1016/j.hrthm.2014.02.009. Epub 2014 Feb 12.
Programming long arrhythmia detection times can reduce the incidence of implantable cardioverter-defibrillator (ICD) shock therapy. However, potential concerns exist regarding the impact on mortality and incidence of syncope.
The purpose of this study was to perform a meta-analysis to better gauge the impact of prolonged arrhythmia detection times on the rates of ICD shock therapy and other adverse outcomes.
Electronic databases were systematically searched. We included only prospective studies that examined the impact of programming longer vs shorter ICD arrhythmia detection times on clinical outcomes. Studies that were retrospective, did not have a control group, used historical controls, or did not specifically state the programmed detection times were excluded. Summary estimates of the relative risk (RR) of death, syncope, and appropriate and inappropriate shocks were calculated using random effects models.
Four studies enrolling 4896 patients were identified. During a mean/median follow-up of 12 to 17 months, there were 305 deaths, 106 patients experienced syncope, 264 received an appropriate shock, and 253 an inappropriate shock. In the long detection group there were significant reductions in mortality (RR 0.77, 95% confidence interval [CI] 0.62, 0.96), and inappropriate shocks (RR 0.50, 95% CI 0.39, 0.65), without significant increase in syncope (RR 1.23, 95% CI 0.84, 1.79).
Programming long arrhythmia detection times is an important strategy for improving outcomes from ICD therapy. The use of long detection times can significantly decrease the burden of inappropriate shock therapy and all-cause mortality in ICD recipients, without significant increase in syncope.
编程长的心律失常检测时间可以减少植入式心脏复律除颤器（ICD）电击治疗的发生率。然而，人们对其对死亡率和晕厥发生率的影响存在潜在担忧。
本研究旨在进行荟萃分析，以更好地评估延长心律失常检测时间对 ICD 电击治疗率和其他不良结局的影响。
系统检索电子数据库。我们仅纳入了前瞻性研究，这些研究检查了编程更长 vs 更短的 ICD 心律失常检测时间对临床结局的影响。排除了回顾性研究、没有对照组、使用历史对照或未明确说明编程检测时间的研究。使用随机效应模型计算死亡率、晕厥和适当及不适当电击的相对风险（RR）的汇总估计值。
确定了四项纳入 4896 名患者的研究。在平均/中位数随访 12 至 17 个月期间，有 305 人死亡，106 人出现晕厥，264 人接受了适当电击，253 人接受了不适当电击。在长检测组中，死亡率（RR 0.77，95%置信区间 [CI] 0.62，0.96）和不适当电击（RR 0.50，95% CI 0.39，0.65）显著降低，而晕厥发生率（RR 1.23，95% CI 0.84，1.79）无显著增加。
编程长的心律失常检测时间是改善 ICD 治疗结果的重要策略。使用长检测时间可显著降低 ICD 接受者的不适当电击治疗负担和全因死亡率，而晕厥发生率无显著增加。
