Alonso Pau, Osca Joaquín, Cano Oscar, Pimenta Pedro, Andrés Ana, Yagüe Jaime, Millet José, Rueda Joaquín, Sancho-Tello María José
Electrophysiology Section, Cardiology Department, La Fe University Hospital, Valencia, Spain.
BioITACA, Polytechnic University of Valencia, Valencia, Spain.
Pacing Clin Electrophysiol. 2017 Feb;40(2):145-153. doi: 10.1111/pace.13017.
Information regarding suitability for subcutaneous implantable cardioverter-defibrillator (S-ICD) implant in tetralogy of Fallot (ToF) population is scarce and needs to be further explored.
(1) to determine the proportion of patients with ToF eligible for S-ICD, (2) to identify the optimal sensing vector in ToF patients, (3) to test specifically the eligibility for S-ICD with right-sided screening, and (4) to compare with the proportion of eligible patients in a nonselected ICD population.
We recruited 60 consecutive patients with ToF and 40 consecutive nonselected patients. Conventional electrocardiographic screening was performed as usual. Right-sided alternative screening was studied by positioning the left arm and right arm electrodes 1 cm right lateral to the xiphoid midline. The Boston Scientific electrocardiogram (ECG) screening tool was utilized.
We found a higher proportion of patients with right-sided positive screening in comparison with standard screening (77 ± 0.4% vs. 67 ± 0.4%; P < 0.0001) and a trend to higher number of appropriate leads in right-sided screening (1.3 ± 1 vs. 1.1 ± 1 ms; P = 0.07). Patients who failed the screening had a longer QRS duration and longer QT interval. Standard and right-sided screening showed a higher percent of positive patients in the control group compared to ToF patients (P < 0.001).
Right-sided screening was associated with a significant 10% increase in S-ICD eligibility in ToF patients. When comparing with an acquired cardiomyopathies group, ToF showed a lower eligibility for S-ICD. The most appropriate ECG vector was the alternate vector in contrast to what is observed in the general population.
关于法洛四联症（ToF）患者适合皮下植入式心律转复除颤器（S-ICD）植入的信息稀缺，需要进一步探索。
（1）确定适合S-ICD的ToF患者比例；（2）确定ToF患者的最佳感知向量；（3）通过右侧筛查专门测试S-ICD的适用性；（4）与非选择性ICD人群中的合格患者比例进行比较。
我们连续招募了60例ToF患者和40例连续的非选择性患者。照常进行常规心电图筛查。通过将左臂和右臂电极置于剑突中线右侧1 cm处研究右侧替代筛查。使用波士顿科学公司的心电图（ECG）筛查工具。
我们发现与标准筛查相比，右侧阳性筛查的患者比例更高（77±0.4%对67±0.4%；P<0.0001），并且右侧筛查中合适导联数量有增加的趋势（1.3±1对1.1±1 ms；P = 0.07）。筛查失败的患者QRS持续时间更长，QT间期更长。与ToF患者相比，标准筛查和右侧筛查在对照组中显示出更高的阳性患者百分比（P<0.001）。
右侧筛查使ToF患者的S-ICD适用性显著增加10%。与获得性心肌病组相比，ToF患者的S-ICD适用性较低。与普通人群中观察到的情况相反，最合适的ECG向量是替代向量。
