Brouwer Tom F, Kooiman Kirsten M, Olde Nordkamp Louise R, van Halm Vokko P, Knops Reinoud E
Heart Center, Department of Clinical and Experimental Cardiology and Cardiothoracic Surgery, Academic Medical Center, Amsterdam, the Netherlands.
Heart Center, Department of Clinical and Experimental Cardiology and Cardiothoracic Surgery, Academic Medical Center, Amsterdam, the Netherlands.
JACC Clin Electrophysiol. 2016 Oct;2(5):605-614. doi: 10.1016/j.jacep.2016.02.011. Epub 2016 May 18.
The study sought to describe the concept of algorithm-based screening with an external subcutaneous implantable cardioverter-defibrillator (S-ICD) to evaluate sensing using the rhythm discrimination algorithm of the device.
In a proportion of patients, screening for S-ICD therapy with the dedicated screening tool results in false negative and false positive results.
Both patients who failed the standard screening and who passed with abnormal baseline ECGs were screened with an external S-ICD to evaluate sensing at rest and during exercise in all 3 sensing vectors (algorithm-based screening). Patients with adequate sensing were implanted with an S-ICD. Follow-up data regarding (in)appropriate shocks was collected.
Algorithm-based screening was performed in 15 patients. Group 1 consists of 8 who failed standard screening and Group 2 consists of 7 who passed and had abnormal ECGs. Six of 8 who failed standard screening in all sensing vectors demonstrated adequate sensing with the external S-ICD and were implanted with an S-ICD. Of these 6 implanted patients in Group 1, 1 inappropriate shock was observed duration median of 17 months' follow-up and 2 episodes of ventricular fibrillation were successfully treated. Of the 7 patients in Group 2, who passed standard screening, 2 demonstrated inadequate sensing during additional screening with the external S-ICD. No appropriate or inappropriate shocks were observed in Group 2 during 10 months' follow-up.
Algorithm-based screening with the external S-ICD may improve patient selection and reduce the number of false positive and false negative screening results of the standard screening method.
本研究旨在描述使用外部皮下植入式心脏复律除颤器（S-ICD）进行基于算法的筛查概念，以利用该设备的节律识别算法评估感知功能。
在一部分患者中，使用专用筛查工具进行S-ICD治疗筛查会产生假阴性和假阳性结果。
对标准筛查失败以及基线心电图异常但通过标准筛查的患者，均使用外部S-ICD进行筛查，以评估所有3个感知向量在静息和运动时的感知功能（基于算法的筛查）。感知功能良好的患者植入S-ICD。收集有关（不）适当电击的随访数据。
对15例患者进行了基于算法的筛查。第1组包括8例标准筛查失败的患者，第2组包括7例通过标准筛查且心电图异常的患者。在所有感知向量中标准筛查失败的8例患者中，有6例使用外部S-ICD时显示感知功能良好，并植入了S-ICD。在第1组的这6例植入患者中，在中位17个月的随访期间观察到1次不适当电击，成功治疗了2次室颤发作。在第2组通过标准筛查的7例患者中，有2例在使用外部S-ICD进行额外筛查时显示感知功能不足。在第2组10个月的随访期间未观察到适当或不适当的电击。
使用外部S-ICD进行基于算法的筛查可能会改善患者选择，并减少标准筛查方法的假阳性和假阴性筛查结果数量。
