Larbig Robert, Motloch Lukas J, Bettin Markus, Fischer Alicia, Frommeyer Gerrit, Reinke Florian, Loeher Andreas, Eckardt Lars, Köbe Julia
Division of Electrophysiology, Department of Cardiovascular Medicine, University of Muenster, Muenster, Germany.
Department of Internal Medicine II, Paracelsus Medical University, Salzburg, Austria.
Pacing Clin Electrophysiol. 2018 Jun;41(6):567-571. doi: 10.1111/pace.13327. Epub 2018 Apr 25.
T-wave oversensing (TWOS) is a feared complication after subcutaneous implantable cardioverter-defibrillator (S-ICD) implantation, potentially leading to inappropriate shocks (IS) with tremendous impact on quality of life.
Postoperative ergometry facilitates primary and secondary prevention of TWOS or other potential causes of IS and optimizes S-ICD programming.
We analyze the impact of ergometry guided-programming (EMGP) on primary and secondary prevention of TWOS/IS in S-ICD patients, we screened 146 patients implanted in our center (2010-2016) for the incidence of TWOS/IS during postoperative ergometry. Furthermore, to evaluate the outcome in 123 eligible patients complete follow-up (FU) of at least 6 months up to 2 years was retrospectively analyzed.
(1) Primary prevention: TWOS could only be provoked postoperatively in 3.7% of patients (n = 3/82). FU analyses did not reveal significant differences compared to our control group (Ctrl: n = 6/61, 9.8% vs EMGP: n = 5/62, 8.1%; P = 0.731). Further subgroup analyses of patients with postoperative ergometry in the close postoperative period (< 7 days; n = 3/45, 6.7%; P = 0.563) did not yield any significant difference. (2) Secondary prevention: We found various causes of TWOS/IS. In patients who underwent reprogramming due to previous TWOS/IS events we observed a 66.7% (n = 6/9) reduction of TWOS/IS using EMGP.
TWOS/IS has various causes while not all cases are exercise-associated. Postoperative ergometry does not seem to be useful for primary prevention. Further trials need to investigate the potential benefit of EMGP for secondary prevention of TWOS/IS.
T波感知过度（TWOS）是皮下植入式心律转复除颤器（S-ICD）植入术后令人担忧的并发症，可能导致不适当电击（IS），对生活质量产生巨大影响。
术后运动试验有助于TWOS或其他IS潜在原因的一级和二级预防，并优化S-ICD程控。
我们分析运动试验指导程控（EMGP）对S-ICD患者TWOS/IS一级和二级预防的影响，筛选了我院中心2010年至2016年植入的146例患者，观察术后运动试验期间TWOS/IS的发生率。此外，为评估123例符合条件患者的结局，对其进行了至少6个月至2年的完整随访（FU），并进行回顾性分析。
（1）一级预防：术后仅3.7%（n = 3/82）的患者可诱发TWOS。随访分析显示，与对照组相比无显著差异（对照组：n = 6/61，9.8%；EMGP组：n = 5/62，8.1%；P = 0.731）。对术后近期（< 7天）进行运动试验的患者进一步亚组分析（n = 3/45，6.7%；P = 0.563），未发现任何显著差异。（2）二级预防：我们发现了TWOS/IS的多种原因。在因既往TWOS/IS事件而进行重新程控的患者中，使用EMGP后TWOS/IS减少了66.7%（n = 6/9）。
TWOS/IS有多种原因，并非所有病例都与运动相关。术后运动试验似乎对一级预防无用。需要进一步试验研究EMGP对TWOS/IS二级预防的潜在益处。
