Hayashi Yusuke, Takagi Masahiko, Kakihara Jun, Sakamoto Shogo, Doi Atsushi, Sugioka Kenichi, Hanatani Akihisa, Yoshiyama Minoru
Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan.
Heart Vessels. 2017 Feb;32(2):175-185. doi: 10.1007/s00380-016-0850-x. Epub 2016 Jun 3.
Several trials demonstrated that a long detection interval and a high-rate cutoff reduced implantable cardioverter-defibrillator (ICD) therapy in primary prevention patients. However, only a few data are available for secondary prevention (SP) patients. The aim of this study was to evaluate whether these ICD programming would be effective in reducing ICD therapies in SP patients. We enrolled 65 SP patients under ICD or cardiac resynchronization therapy with the defibrillator programmed with the same setting (conventional setting). During follow-up, we changed detection rates in each zone; cycle length (CL) ≤400 to ≤370 ms for ventricular tachycardia (VT) zone, CL ≤350 to ≤320 ms for fast VT zone, CL ≤300 to ≤270 ms for ventricular fibrillation (VF) zone, and number of intervals to detect ventricular tachyarrhythmia in VF zone: 12-24. We retrospectively compared the incidences of ICD therapies, syncope, and hospitalization due to slow VT under the detection rate between both settings. Median follow-up periods were 5.0 (interquartile range 2.5-7.8) and 2.5 years (interquartile range 2.3-2.7) in conventional and strategic settings, respectively. The incidence of appropriate ATP and shock significantly decreased in strategic setting (conventional and strategic settings: 21.2 and 4.8 ATPs per year, respectively, OR 0.18, 95 % CI 0.06-0.54, p = 0.002, 26.1 and 7.8 shocks per year, respectively, OR 0.29, 95 % CI 0.09-0.88, p = 0.03). The incidence of overall inappropriate therapy significantly decreased (conventional and strategic settings: 17.6 and 2.8 therapies per year, respectively, OR 0.14, 95 % CI 0.05-0.44, p = 0.01). The incidence of syncope and slow VT was not significantly different between both settings. In conclusion, ICD programming-combined long detection interval with high-rate cutoff was effective in reducing appropriate shock and inappropriate therapy without increasing the incidence of syncope and slow VT in SP patients.
多项试验表明，较长的检测间期和较高的心率截断值可减少一级预防患者的植入式心律转复除颤器（ICD）治疗。然而，关于二级预防（SP）患者的数据却很少。本研究的目的是评估这些ICD程控设置在减少SP患者的ICD治疗方面是否有效。我们纳入了65例接受ICD或心脏再同步治疗加除颤器的SP患者，其除颤器设置为相同的常规设置。在随访期间，我们改变了每个区域的检测率；室性心动过速（VT）区域的周长（CL）从≤400毫秒改为≤370毫秒，快速VT区域的CL从≤350毫秒改为≤320毫秒，心室颤动（VF）区域的CL从≤300毫秒改为≤270毫秒，VF区域检测室性快速心律失常的间期数量从12 - 24个。我们回顾性比较了两种设置下检测率对应的ICD治疗、晕厥和因缓慢VT住院的发生率。常规设置和策略性设置的中位随访期分别为5.0年（四分位间距2.5 - 7.8年）和2.5年（四分位间距2.3 - 2.7年）。在策略性设置下，恰当的抗心动过速起搏（ATP）和电击发生率显著降低（常规设置和策略性设置：每年分别为21.2次和4.8次ATP，OR 0.18，95%CI 0.06 - 0.54，p = 0.002；每年分别为26.1次和7.8次电击，OR 0.29，95%CI 0.09 - 0.88，p = 0.03）。总体不恰当治疗的发生率显著降低（常规设置和策略性设置：每年分别为17.6次和2.8次治疗，OR 0.14，95%CI 0.05 - 0.44，p = 0.01）。两种设置下晕厥和缓慢VT的发生率无显著差异。总之，ICD程控设置——长检测间期与高心率截断值相结合，在不增加SP患者晕厥和缓慢VT发生率的情况下，有效减少了恰当电击和不恰当治疗。
