University of British Columbia, Vancouver, British Columbia, Canada.
Medtronic, Mounds View, Minnesota.
Heart Rhythm. 2022 Feb;19(2):219-225. doi: 10.1016/j.hrthm.2021.10.010. Epub 2021 Oct 15.
Recent evidence has revealed the utility of prolonged arrhythmia detection duration and increased rate cutoff to reduce implantable cardioverter-defibrillator (ICD) therapies. Data on real-world trends in ICD programming and its impact on outcomes are limited.
The purpose of this study was to evaluate trends in ICD programming and its impact on ICD therapy using a large remote monitoring database.
A retrospective analysis of patients with ICD implanted from 2007 to 2018 was conducted using the de-identified Medtronic CareLink database. Data on ICD programming (number of intervals to detection [NID] and therapy rate cutoff) and delivered ICD therapies were collected.
Among 210,810 patients, the proportion programmed to a rate cutoff of ≥188 beats/min increased from 41% to 49% and an NID of ≥30/40 increased from 17% to 67% before May 2013 vs after February 2016. Programming to a rate cutoff of ≥188 beats/min, a ventricular fibrillation (VF) NID of ≥30/40, or a combined rate cutoff of ≥188 beats/min and VF NID of ≥30/40 were associated with reductions in ICD therapy. The largest reductions in ICD therapy occurred when the combination of rate cutoff ≥ 188 beats/min and VF NID ≥ 30/40 was programmed (antitachycardia pacing: hazard ratio [HR] 0.35; 95% confidence interval [CI] 0.34-0.36; P < .001; shocks: HR 0.67; 95% CI 0.65-0.69; P < .001; and antitachycardia pacing/shocks: HR 0.43; 95% CI 0.42-0.44; P < .001).
Despite evidence supporting the use of prolonged detection duration and high rate cutoff, implementation of shock reduction programming strategies in real-world clinical practice has been modest. The use of evidence-based ICD programming is associated with reduced ICD shocks over long-term follow-up.
最近的证据表明，延长心律失常检测时间和提高心率截止值有助于减少植入式心脏复律除颤器（ICD）治疗。关于 ICD 编程的实际趋势及其对结果的影响的数据有限。
本研究旨在使用大型远程监测数据库评估 ICD 编程的趋势及其对 ICD 治疗的影响。
使用去标识的美敦力 CareLink 数据库对 2007 年至 2018 年期间植入 ICD 的患者进行回顾性分析。收集 ICD 编程（检测间隔数 [NID] 和治疗率截止值）和所给 ICD 治疗的数据。
在 210810 名患者中，设定心率截止值≥188 次/分钟的比例从 2013 年 5 月前的 41%增加到 2016 年 2 月后的 49%，设定 NID≥30/40 的比例从 17%增加到 67%。设定心率截止值≥188 次/分钟、VF NID≥30/40 或设定心率截止值≥188 次/分钟和 VF NID≥30/40 的组合与 ICD 治疗减少相关。当设定组合心率截止值≥188 次/分钟和 VF NID≥30/40 时，ICD 治疗的减少幅度最大（抗心动过速起搏：危险比 [HR] 0.35；95%置信区间 [CI] 0.34-0.36；P<.001；电击：HR 0.67；95%CI 0.65-0.69；P<.001；抗心动过速起搏/电击：HR 0.43；95%CI 0.42-0.44；P<.001）。
尽管有证据支持延长检测时间和提高心率截止值的使用，但在实际临床实践中实施减少电击编程策略的情况并不多见。使用基于证据的 ICD 编程与长期随访的 ICD 电击减少相关。
