Ogano Michio, Iwasaki Yu-Ki, Tsuboi Ippei, Kawanaka Hidekazu, Tajiri Masaharu, Takagi Hisato, Tanabe Jun, Shimizu Wataru
Department of Cardiovascular Medicine, Shizuoka Medical Center, 762-1 Nagasawa, Shimizu, Sunto Shizuoka 4110906, Japan.
Department of Cardiovascular Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo, Tokyo 1138603, Japan.
Int J Cardiol Heart Vasc. 2018 Dec 29;22:78-81. doi: 10.1016/j.ijcha.2018.12.012. eCollection 2019 Mar.
Some patients who undergo implantation of cardiac resynchronization therapy with defibrillator (CRT-D) survive long enough, thus requiring CRT-D battery replacement. Defibrillator therapy might become unnecessary in patients who have had significant clinical improvement and recovery of left ventricular ejection fraction (LVEF) after CRT-D implantation.
Forty-nine patients who needed replacement of a CRT-D battery were considered for exchange of CRT-D for cardiac resynchronization therapy with pacemaker (CRT-P) if they met the following criteria: LVEF >45%; the indication for an implantable cardioverter defibrillator was primary prevention at initial implantation and no appropriate implantable cardioverter defibrillator therapy was documented after initial implantation of the CRT-D.
Seven patients (14.2%) were undergone a downgrade from CRT-D to CRT-P without any complications. No ventricular tachyarrhythmic events were observed during a mean follow-up of 39.7 ± 21.1 months and there was no significant change in LVEF between before and 1 year after device replacement (53.5% ± 6.2% vs. 56.4% ± 7.3%, = 0.197).
This study confirmed mid-term feasibility and safety of downgrade from CRT-D to CRT-P alternative to conventional replacement with CRT-D.
一些接受心脏再同步治疗除颤器（CRT-D）植入的患者存活时间足够长，因此需要更换CRT-D电池。对于在CRT-D植入后临床有显著改善且左心室射血分数（LVEF）恢复的患者，除颤治疗可能不再必要。
49例需要更换CRT-D电池的患者，如果符合以下标准，则考虑将CRT-D更换为心脏再同步治疗起搏器（CRT-P）：LVEF>45%；植入式心律转复除颤器的适应证为初始植入时的一级预防，且在CRT-D初始植入后未记录到适当的植入式心律转复除颤器治疗。
7例患者（14.2%）从CRT-D降级为CRT-P，无任何并发症。在平均39.7±21.1个月的随访期间，未观察到室性快速心律失常事件，设备更换前和更换后1年LVEF无显著变化（53.5%±6.2%对56.4%±7.3%，P=0.197）。
本研究证实了从CRT-D降级为CRT-P替代传统CRT-D更换的中期可行性和安全性。
