Waikato Hospital, Hamilton, New Zealand.
Centre Hospitalier Universitaire Trousseau, Université François Rabelais, Tours, France.
Europace. 2019 Sep 1;21(9):1442-1443. doi: 10.1093/europace/euz065.
The 2015 HRS/EHRA/APHRS/SOLAECE Expert Consensus Statement on Optimal Implantable Cardioverter-Defibrillator Programming and Testing provided guidance on bradycardia programming, tachycardia detection, tachycardia therapy, and defibrillation testing for implantable cardioverter-defibrillator (ICD) patient treatment. The 32 recommendations represented the consensus opinion of the writing group, graded by Class of Recommendation and Level of Evidence. In addition, Appendix B provided manufacturer-specific translations of these recommendations into clinical practice consistent with the recommendations within the parent document. In some instances, programming guided by quality evidence gained from studies performed in devices from some manufacturers was translated such that this programming was approximated in another manufacturer's ICD programming settings. The authors found that the data, although not formally tested, were strong, consistent, and generalizable beyond the specific manufacturer and model of ICD. As expected, because these recommendations represented strategic choices to balance risks, there have been reports in which adverse outcomes were documented with ICDs programmed to Appendix B recommendations. The recommendations have been reviewed and updated to minimize such adverse events. Notably, patients who do not receive unnecessary ICD therapy are not aware of being spared potential harm, whereas patients in whom their ICD failed to treat life-threatening arrhythmias have their event recorded in detail. The revised recommendations employ the principle that the randomized trials and large registry data should guide programming more than anecdotal evidence. These recommendations should not replace the opinion of the treating physician who has considered the patient's clinical status and desired outcome via a shared clinical decision-making process.
2015 年 HRS/EHRA/APHRS/SOLAECE 专家共识声明关于优化植入式心脏复律除颤器的程控和测试，为植入式心脏复律除颤器（ICD）患者的治疗提供了关于心动过缓程控、心动过速检测、心动过速治疗和除颤测试的指导。这 32 条建议代表了写作小组的共识意见，按推荐类别和证据水平进行分级。此外，附录 B 提供了制造商特定的建议翻译，这些翻译与主要文件中的建议一致，符合临床实践。在某些情况下，根据一些制造商的设备中进行的研究获得的高质量证据进行编程，以在另一个制造商的 ICD 编程设置中近似这种编程。作者发现，这些数据虽然没有经过正式测试，但具有很强的一致性和可推广性，不仅限于特定的制造商和 ICD 模型。正如预期的那样，由于这些建议代表了平衡风险的战略选择，因此已经有报告记录了根据附录 B 建议编程的 ICD 出现不良后果。这些建议已经过审查和更新，以尽量减少此类不良事件。值得注意的是，那些没有接受不必要的 ICD 治疗的患者并不知道自己避免了潜在的伤害，而那些 ICD 未能治疗危及生命的心律失常的患者则详细记录了他们的事件。修订后的建议采用了随机试验和大型注册数据应该比轶事证据更能指导编程的原则。这些建议不应取代治疗医生的意见，治疗医生已经通过共同的临床决策过程考虑了患者的临床状况和期望的结果。
