Ziacchi Matteo, Corzani Alessandro, Diemberger Igor, Martignani Cristian, Marziali Alessandro, Mazzotti Andrea, Massaro Giulia, Rapezzi Claudio, Biffi Mauro, Boriani Giuseppe
Institute of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, S.Orsola-Malpighi University Hospital, Bologna, Italy.
Institute of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, S.Orsola-Malpighi University Hospital, Bologna, Italy.
Heart Lung Circ. 2016 May;25(5):476-83. doi: 10.1016/j.hlc.2015.10.016. Epub 2015 Nov 18.
The subcutaneous implantable cardioverter-defibrillator (S-ICD) is used in patients at risk of sudden death. Our aim was to assess clinical predictors of electrocardiographic ineligibility for S-ICD, and the impact of exercise on S-ICD eligibility in an unselected series of patients requiring ICD therapy.
102 patients at risk of sudden death were evaluated at rest and during exercise. Electrocardiograph screening using limb lead electrodes (to simulate the S-ICD sensing vectors) was performed at rest and during bicycle ergometer exercise.
R wave amplitude in lead D3 during exercise >16mV, baseline QTc and the sum of amplitudes of the R waves at supine >30mV were predictors of ineligibility for S-ICD. Eligibility increased from 90% to 100% of patients when evaluated with an "any of the three leads" criterion compared to current recommendations. A more restrictive criterion based on two of three ECG leads caused an eligibility drop at 66%, that further decreased to 56% during exercise; these figures improved to 79% and 81%, respectively, when an "any 2 of 3 leads" criterion was used.
Huge ECG amplitude and QTc duration are associated with ineligibility in the current S-ICD release. By performing exercise testing, lead suitability changes in one patient out of 14 (7% of tested patients) and eligibility is decreased by use of a more stringent criterion for eligibility (ECG criteria satisfied in two of three leads). A dynamic selection of sensing vectors aiming at situation-specific suitability (any of three leads) would increase S-ICD eligibility to 100% of patients.
皮下植入式心律转复除颤器（S-ICD）用于有猝死风险的患者。我们的目的是评估心电图不符合S-ICD植入标准的临床预测因素，以及运动对一系列未经选择的需要ICD治疗的患者中S-ICD植入资格的影响。
对102例有猝死风险的患者在静息和运动期间进行评估。使用肢体导联电极（模拟S-ICD感知向量）在静息和自行车测力计运动期间进行心电图筛查。
运动期间D3导联R波振幅>16mV、基线QTc以及仰卧位时R波振幅总和>30mV是不符合S-ICD植入标准的预测因素。与当前建议相比，采用“三根导联中的任何一根”标准评估时，患者的植入资格从90%提高到100%。基于三根心电图导联中的两根的更严格标准导致植入资格降至66%，运动期间进一步降至56%；当使用“三根导联中的任意两根”标准时，这些数字分别提高到79%和81%。
巨大的心电图振幅和QTc持续时间与当前S-ICD版本的植入不合格相关。通过进行运动测试，14名患者中有1名（占测试患者的7%）的导联适用性发生变化，并且使用更严格的植入标准（三根导联中的两根满足心电图标准）会降低植入资格。针对特定情况的适用性（三根导联中的任何一根）动态选择感知向量将使100%的患者符合S-ICD植入资格。
