Lee Woo Seok, Kim Jun, Kwon Chang-Hee, Choi Jin Hee, Jo Uk, Kim Yoo Ri, Nam Gi-Byoung, Choi Kee-Joon, Kim You-Ho
Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Korean Circ J. 2016 Mar;46(2):179-85. doi: 10.4070/kcj.2016.46.2.179. Epub 2016 Mar 21.
Implantable cardioverter-defibrillators (ICDs) are indicated in patients with Brugada syndrome (BS), early repolarization syndrome (ERS), or idiopathic ventricular fibrillation (IVF) who are at high risk for sudden cardiac death. The optimal ICD programming for reducing inappropriate shocks in these patients remains to be determined. We investigated the difference in the mean cycle length of tachyarrhythmias that activated either appropriate or inappropriate ICD shocks in these three patient groups to determine the optimal ventricular fibrillation (VF) zone for minimizing inappropriate ICD shocks.
We selected 41 patients (35 men) (mean age±standard deviation=42.6±13.0 year) who received ICD shocks between April 1996 and April 2014 to treat BS (n=24), ERS (n=9), or IVF (n=8). Clinical and ICD interrogation data were retrospectively collected and analyzed for all events with ICD shocks.
Of the 244 episodes, 180 (73.8%) shocks were appropriate and 64 (26.2%) were inappropriate. The mean cycle lengths of the tachyarrhythmias that activated appropriate and inappropriate shocks were 178.9±28.7 ms and 284.8±24.4 ms, respectively (p<0.001). The cutoff value with the highest sensitivity and specificity for discriminating between appropriate and inappropriate shocks was 235 ms (sensitivity, 98.4%; specificity, 95.6%). When we programmed a single VF zone of ≤270 ms, inappropriate ICD shocks were reduced by 70.5% and appropriate shocks were missed in 1.7% of these patients.
Programming of a single VF zone of ≤270 ms in patients with BS, ERS, or IVF could reduce inappropriate ICD shocks, with a low risk of missing appropriate shocks.
对于患有Brugada综合征（BS）、早期复极综合征（ERS）或特发性室颤（IVF）且有心脏性猝死高风险的患者，植入式心律转复除颤器（ICD）是适用的。然而，对于减少这些患者不适当电击的最佳ICD程控设置仍有待确定。我们研究了这三组患者中激活适当或不适当ICD电击的快速心律失常的平均周期长度差异，以确定使不适当ICD电击最少的最佳室颤（VF）区。
我们选取了41例患者（35例男性）（平均年龄±标准差 = 42.6±13.0岁），这些患者在1996年4月至2014年4月期间接受了ICD电击治疗，其中治疗BS的有24例，ERS的有9例，IVF的有8例。对所有发生ICD电击的事件进行回顾性收集临床及ICD问询数据并分析。
在244次发作中，180次（73.8%）电击是适当的，64次（26.2%）是不适当的。激活适当和不适当电击的快速心律失常的平均周期长度分别为178.9±28.7毫秒和284.8±24.4毫秒（p<0.001）。区分适当和不适当电击的敏感度和特异度最高的临界值为235毫秒（敏感度，98.4%；特异度，95.6%）。当我们将单一VF区程控设置为≤270毫秒时，这些患者中不适当ICD电击减少了70.5%，适当电击漏检率为1.7%。
对患有BS、ERS或IVF的患者将单一VF区程控设置为≤270毫秒可减少不适当ICD电击，且适当电击漏检风险较低。
