一种新型的筛查工具，用于揭示 S-ICD 和左心室辅助装置之间潜在的干扰。
A novel screening tool to unmask potential interference between S-ICD and left ventricular assist device.
机构信息
Hannover Heart Rhythm Center, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany.
Department of Cardiac, Thoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany.
出版信息
J Cardiovasc Electrophysiol. 2020 Dec;31(12):3286-3292. doi: 10.1111/jce.14769. Epub 2020 Oct 14.
INTRODUCTION
In patients with a left ventricular assist device (LVAD), the subcutaneous implantable cardioverter-defibrillator (S-ICD) can be an alternative to transvenous ICD systems due to reduced risk of systemic infection, which could lead to extraction of the ICD as well as the LVAD. S-ICD eligibility is lower in patients with LVAD than in patients with end-stage heart failure without LVAD. Several reports have shown inappropriate S-ICD therapy in the coexistence of LVAD and S-ICD. The aim of the present study was to evaluate S-ICD eligibility in patients with LVAD using the established electrocardiogram (ECG)-based screening test as well as a novel device-based screening test to identify potentially inappropriate S-ICD sensing in this specific patient cohort.
METHODS AND RESULTS
The present study included 115 patients implanted with an LVAD. The standard ECG-based screening test and a novel device-based screening test were performed in all patients. Eighty patients (70%) were eligible for S-ICD therapy with the standard ECG-based screening test. Performance of the novel device-based screening test identified device-device interference in 14 of these 80 patients (12%).
CONCLUSION
Using a novel extended device-based S-ICD screening method, a small number of patients with LVAD deemed eligible for S-ICD with the standard ECG-based screening test exhibit device-device interference. Careful S-ICD screening should be performed in patients with LVAD, who are candidates for S-ICD therapy, to prevent inappropriate sensing or ICD therapy.
简介
在左心室辅助装置（LVAD）患者中，由于系统感染风险降低，可将皮下植入式心律转复除颤器（S-ICD）作为经静脉植入式心律转复除颤器系统的替代方法，这可能导致 ICD 和 LVAD 的取出。与没有 LVAD 的终末期心力衰竭患者相比，LVAD 患者的 S-ICD 适应证较低。有几项报告显示，在 LVAD 与 S-ICD 共存的情况下，S-ICD 治疗不当。本研究旨在使用已建立的心电图（ECG）为基础的筛查试验和一种新型基于设备的筛查试验，评估 LVAD 患者的 S-ICD 适应证，以确定在这一特定患者群体中，S-ICD 感知的潜在不适当性。
方法和结果
本研究共纳入 115 例植入 LVAD 的患者。所有患者均进行标准 ECG 为基础的筛查试验和新型基于设备的筛查试验。标准 ECG 为基础的筛查试验有 80 例患者（70%）符合 S-ICD 治疗适应证。新型基于设备的筛查试验发现，在这 80 例患者中有 14 例（12%）存在设备间干扰。
结论
使用新型扩展基于设备的 S-ICD 筛查方法，在符合标准 ECG 为基础的筛查试验标准的、被认为适合 S-ICD 的少数 LVAD 患者中，存在设备间干扰。应在 LVAD 患者中仔细进行 S-ICD 筛查，这些患者是 S-ICD 治疗的候选者，以防止出现不适当的感知或 ICD 治疗。
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