Tachibana Motomi, Nishii Nobuhiro, Banba Kimikazu, Fujita Shinpei, Ikeda Etsuko, Okawa Keisuke, Morita Hiroshi, Ito Hiroshi
Department of Cardiology Sakakibara Heart Institute of Okayama Okayama Japan.
Department of Cardiovascular Therapeutics Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Okayama Japan.
J Arrhythm. 2018 Nov 20;35(1):86-91. doi: 10.1002/joa3.12141. eCollection 2019 Feb.
Compared to screening ECG before implantation of a subcutaneous implantable cardioverter-defibrillator (S-ICD), selectable vectors without T-wave oversensing increase after S-ICD implantation. Newer algorithms have recently become available to reduce T-wave oversensing, such as SMART pass (SP). With this function, more selectable vectors are identified after S-ICD implantation. However, this improvement in eligibility utilizing SP has not yet been well validated. We aimed to clarify S-ICD eligibility before and after S-ICD implantation with and without SP.
Participants comprised 34 patients implanted with an S-ICD at Okayama University Hospital and its affiliated hospitals between February 2016 and August 2017. A total of 102 S-ICD vectors were assessed for eligibility before and after S-ICD implantation, at rest and during exercise testing. Vector availability was evaluated in the presence and absence of SP after S-ICD implantation.
Subcutaneous implantable cardioverter-defibrillator eligibility was significantly better after implantation even without SP than S-ICD screening before S-ICD implantation, both at rest (before 65.7% vs after 95.1%, < 0.01) and during exercise (before 59.3% vs after 90.6%, < 0.01). SP improved S-ICD eligibility during exercise (SP on 97.9% vs off 90.6%, = 0.03). Multivariate analysis showed the prevalence of S-ICD eligibility increased significantly after S-ICD implantation compared to screening before implantation. SP further increased selectable vectors in multivariate analysis.
Available vectors increased significantly after S-ICD implantation compared to preoperative vectors as assessed by S-ICD screening ECG. T-wave oversensing during exercise has been an unresolved issue for S-ICD, but SP will help prevent inappropriate operation with S-ICD.
与皮下植入式心脏复律除颤器（S-ICD）植入前的筛查心电图相比，S-ICD植入后无T波过度感知的可选向量增加。最近出现了更新的算法来减少T波过度感知，如SMART pass（SP）。有了这个功能，S-ICD植入后可识别更多的可选向量。然而，利用SP在合格性方面的这种改善尚未得到充分验证。我们旨在阐明在有和没有SP的情况下，S-ICD植入前后的S-ICD合格性。
研究对象包括2016年2月至2017年8月期间在冈山大学医院及其附属医院植入S-ICD的34例患者。在S-ICD植入前后、静息时和运动试验期间，共评估了102个S-ICD向量的合格性。在S-ICD植入后，在有和没有SP的情况下评估向量可用性。
即使没有SP，皮下植入式心脏复律除颤器的合格性在植入后也显著优于S-ICD植入前的S-ICD筛查，无论是在静息时（植入前为65.7%，植入后为95.1%，<0.01）还是在运动期间（植入前为59.3%，植入后为90.6%，<0.01）。SP改善了运动期间的S-ICD合格性（开启SP时为97.9%，关闭时为90.6%，P = 0.03）。多变量分析显示，与植入前的筛查相比，S-ICD植入后S-ICD合格性的患病率显著增加。在多变量分析中，SP进一步增加了可选向量。
与通过S-ICD筛查心电图评估的术前向量相比，S-ICD植入后可用向量显著增加。运动期间的T波过度感知一直是S-ICD尚未解决的问题，但SP将有助于防止S-ICD的不适当操作。
