Cardiac Electrophysiology, University of Michigan Health System, Ann Arbor, Michigan; Cardiology Division, Department of Internal Medicine, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand.
Division of Cardiology, Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi.
Heart Rhythm. 2020 Jul;17(7):1101-1106. doi: 10.1016/j.hrthm.2020.02.004. Epub 2020 Feb 11.
Inappropriate therapy is a common adverse effect in patients with an implantable cardioverter-defibrillator (ICD) that may be prevented by appropriate programming.
The purpose of this study was to assess the outcomes of device programming based on a 2015 HRS/EHRA/APHRS/SOLAECE expert consensus statement and a 2019 focused update on optimal ICD programming and testing.
Consecutive patients who underwent ICD insertion for primary prevention from 2014-2016 at 3 centers were included in the retrospective analysis. Patients were classified into 2 groups based on the tachycardia programming at the time of implant: guideline concordant group (GC) and non-guideline concordant group (NGC). Kaplan-Meier analysis and Cox proportional hazard models were used to estimate freedom from ICD therapy (antitachycardia pacing or shock), ICD shock, and death.
A total of 772 patients were included in the study (mean age 63.3 ± 13.8 years). Of this total, 258 patients (33.4%) were in the GC group and 514 patients (66.6%) were in the NGC group. During mean follow-up of 2.02 ± 0.91 years, guideline concordant programming was associated with a 53% reduction in ICD therapy (P <.01) and 50% reduction in ICD shock (P = .02). There were no significant differences in mortality (6% in GC group vs11% in NGC group; P = .22).
Only one-third of the studied population had an ICD device programmed in concordance with current guidelines. ICD programming based on the current guidelines was associated with a significantly lower rate of ICD therapy and shock without changes in mortality during intermediate-term follow-up.
在植入式心脏复律除颤器（ICD）患者中，不适当的治疗是一种常见的不良反应，可以通过适当的程控来预防。
本研究旨在评估基于 2015 年 HRS/EHRA/APHRS/SOLAECE 专家共识声明和 2019 年 ICD 程控和测试优化重点更新的设备程控结果。
回顾性分析了 2014 年至 2016 年在 3 个中心因原发性预防植入 ICD 的连续患者。根据植入时的心动过速程控，患者分为两组：指南一致组（GC）和非指南一致组（NGC）。使用 Kaplan-Meier 分析和 Cox 比例风险模型估计 ICD 治疗（抗心动过速起搏或电击）、ICD 电击和死亡的无事件率。
本研究共纳入 772 例患者（平均年龄 63.3 ± 13.8 岁）。其中，258 例（33.4%）为 GC 组，514 例（66.6%）为 NGC 组。在平均 2.02 ± 0.91 年的随访期间，指南一致的程控与 ICD 治疗（P <.01）和 ICD 电击（P =.02）减少 53%和 50%相关。死亡率无显著差异（GC 组 6%，NGC 组 11%；P =.22）。
只有三分之一的研究人群的 ICD 设备程控符合当前指南。基于当前指南的 ICD 程控与 ICD 治疗和电击发生率显著降低相关，中期随访期间死亡率无变化。
