Thomas Vincent C, Peterson Mark, McDaniel Martin, Restrepo Humberto, Rothman Abraham, Jain Amit
University of Nebraska Medical Center, Children's Hospital and Medical Center, 8200 Dodge Street, Omaha, NE, 68164, USA.
Boston Scientific, Marlborough, MA, USA.
Pediatr Cardiol. 2017 Aug;38(6):1162-1168. doi: 10.1007/s00246-017-1635-4. Epub 2017 May 22.
Candidates for the subcutaneous implantable cardioverter-defibrillator (S-ICD) are screened using an electrocardiogram (S-ECG) tool to measure appropriate detection. We sought to define the S-ICD candidacy of congenital heart disease patients using the S-ECG tool. We also analyzed the reliability of the (S-ECG) tool between measurers in this population. Patients above the age of 12 and with a diagnosis associated with either a higher incidence of cardiac arrest or vascular access challenges were asked to undergo screening. S-ECGs were then analyzed by a pediatric electrophysiologist, an S-ICD device engineer, and an S-ICD clinical representative for candidacy. Results were compared for interobserver variability and S-ECGs were analyzed by t test to determine variables that differ among passing and failing leads. Thirty-one patients underwent screening. Two of the 31 (6.5%) patients failed S-ICD screening. Analysis of the screening leads demonstrated the highest passing rates using lead III at a 5 mm/mV amplitude setting with 71 and 62% pass rate in the supine and standing positions, respectively. Interobserver analysis correlated well among the three measurers. There was a higher amplitude difference between QRS and T waves among passing versus failing S-ECG. Congenital heart disease patients have acceptable passage rates utilizing the S-ECG algorithm. Interobserver measurements were well correlated and these data suggest that the proximal coil to device (lead III) vector would be best utilized in this patient population. A larger difference between QRS and T wave amplitudes was associated with a higher S-ECG passing rate.
使用心电图（S-ECG）工具对皮下植入式心脏复律除颤器（S-ICD）的候选者进行筛查，以测量是否能进行适当检测。我们试图使用S-ECG工具来确定先天性心脏病患者的S-ICD候选资格。我们还分析了该人群中测量者之间S-ECG工具的可靠性。年龄在12岁以上且诊断与心脏骤停发生率较高或血管通路存在挑战相关的患者被要求接受筛查。然后由一名儿科电生理学家、一名S-ICD设备工程师和一名S-ICD临床代表对S-ECG进行分析，以确定是否符合候选资格。比较观察者间的变异性结果，并通过t检验分析S-ECG，以确定通过和未通过导联之间存在差异的变量。31名患者接受了筛查。31名患者中有2名（6.5%）未通过S-ICD筛查。对筛查导联的分析表明，在5 mm/mV振幅设置下使用Ⅲ导联时通过率最高，仰卧位和站立位的通过率分别为71%和62%。三位测量者之间的观察者间分析相关性良好。通过与未通过的S-ECG之间，QRS波与T波之间的振幅差异更大。先天性心脏病患者使用S-ECG算法的通过率是可以接受的。观察者间的测量相关性良好，这些数据表明，近端线圈到设备（Ⅲ导联）向量在该患者群体中最适用。QRS波与T波振幅之间的差异越大，S-ECG通过率越高。
