EP Division, Department of Cardiology, Care Hospitals, Hyderabad, India.
Division of Cardiology, Department of Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
Pacing Clin Electrophysiol. 2020 Jun;43(6):573-582. doi: 10.1111/pace.13923. Epub 2020 May 8.
Implantable cardioverter defibrillator (ICD) is recommended for patients with ventricular tachycardia (VT) due to cardiac sarcoidosis (CS). Programming supraventricular tachycardia (SVT) discriminators (onset, stability, and morphology/template match) is generally recommended to minimize inappropriate therapies. However, VT in patients with CS is known to show cycle length variability (CLV) and pleomorphism.
To determine whether the stability criterion, designed to prevent inappropriate therapy during atrial fibrillation with rapid ventricular rates, could potentially lead to incorrect classification of VT as SVT and inappropriately delay or inhibit ICD therapy.
Cases of biopsy-proven CS with VT were analyzed. For patients with implanted devices, all recorded electrograms of tachycardia episodes and ICD therapies were analyzed at last follow up.
A total of 142 patients were included (mean age 38 years, 87 males). One hundred and three of 142 patients had implanted devices (ICD or CRT-D). Thirty eight of 103 (36.9%) patients received appropriate ICD therapies over 3 ± 2.2 years follow up. Four of 38 (10.5%) of patients experienced delayed-detection or underdetection of VT related to CLV, resulting in VT counters being repeatedly "reset" (classified as "unstable" rhythms). Retrospective analysis of other VT episodes in 70 of 103 (68%) patients revealed that 25 of 80 (31.3%) episodes had > 50 ms cycle length oscillations.
Among CS patients with VT, CLV is a common occurrence seen in two-thirds of VT episodes. Routine programming of the stability criterion may result in underdetection of VT in a subset of such patients. We recommend that the stability criterion should be programmed "OFF" for patients with CS, unless the patient has documented atrial fibrillation.
由于心脏结节病（CS），植入式心脏复律除颤器（ICD）推荐用于室性心动过速（VT）患者。通常建议对室上性心动过速（SVT）鉴别器（起始、稳定性和形态/模板匹配）进行编程，以最大程度地减少不适当的治疗。然而，CS 患者的 VT 已知表现出节律长度可变性（CLV）和多形性。
确定旨在防止快速心室率心房颤动期间不适当治疗的稳定性标准是否可能导致 VT 被错误地分类为 SVT，并不适当地延迟或抑制 ICD 治疗。
分析经活检证实的 CS 伴 VT 的病例。对于植入设备的患者，在最后一次随访时分析所有记录的心动过速发作和 ICD 治疗的心电图。
共纳入 142 例患者（平均年龄 38 岁，87 例男性）。142 例患者中有 103 例（87 例男性）植入了设备（ICD 或 CRT-D）。在 3±2.2 年的随访中，38 例（36.9%）患者接受了适当的 ICD 治疗。4 例（10.5%）患者因 CLV 导致 VT 相关检测延迟或检测不足，导致 VT 计数器反复“重置”（被归类为“不稳定”节律）。对 103 例患者中的 70 例（68%）其他 VT 发作的回顾性分析显示，80 例中的 25 例（31.3%）发作的节律长度波动超过 50 毫秒。
在 CS 伴 VT 的患者中，CLV 是三分之二 VT 发作中常见的现象。在这类患者的亚组中，常规编程稳定性标准可能会导致 VT 检测不足。我们建议，除非患者有记录的心房颤动，否则应将稳定性标准编程为“关闭”。
