Department of Cardiovascular Medicine, The University of Kansas Health System, Kansas City, Kansas, USA.
Department of Cardiovascular Surgery, The University of Kansas Health System, Kansas City, Kansas, USA.
Pacing Clin Electrophysiol. 2022 Feb;45(2):204-211. doi: 10.1111/pace.14438. Epub 2022 Jan 17.
Patients with left ventricular assist devices (LVAD) often tolerate ventricular arrhythmias (VA). We aim to assess the frequency and outcomes of ICD therapies averted by ultraconservative ICD programming (UCP) in LVAD patients.
This single center, retrospective cohort study included patients with LVADs and ICDs implanted from 2015 to 2019 that had UCP. The aim for UCP was to maximally delay VA treatments and maximize anti-tachycardia pacing (ATP) prior to ICD shocks. VA events were reviewed after UCP and evaluated under prior conservative programming to assess for potentially averted events (that would have resulted in either ATP or defibrillation with prior programming).
Fifty patients were included in the study with follow-up of median 16 ± 10.2 months after UCP. The median time from LVAD implantation to reprogramming was 7 days (IQR 5-9 days). Fourteen patients (28%) had potentially averted VA events that would have been treated with their prior ICD programming (82 total events, median two events per patient, IQR 1-10 events). Treated VA events occurred in 15 patients (30%). Eleven of the 14 patients with potentially averted VAs had treated events as well. Only one patient reported definitive symptoms of self-limited "dizziness" during a potentially averted event that did not result in hospitalization. No patients died of complications from or needed emergent care/hospitalization due a potentially averted VA.
UCP in LVAD patients likely prevented unnecessary VA treatments in many patients with minimal reported symptoms during these potentially averted events. Prospective studies are necessary to confirm these findings.
植入左心室辅助装置（LVAD）的患者通常能耐受室性心律失常（VA）。我们旨在评估超保守 ICD 程控（UCP）避免 LVAD 患者 ICD 治疗的频率和结果。
这是一项单中心、回顾性队列研究，纳入了 2015 年至 2019 年植入 LVAD 和 ICD 且进行 UCP 的患者。UCP 的目的是最大限度地延迟 VA 治疗，并在 ICD 电击前最大限度地增加抗心动过速起搏（ATP）。在 UCP 后回顾 VA 事件，并根据先前的保守编程进行评估，以评估潜在的可避免事件（这将导致先前编程的 ATP 或除颤）。
研究纳入了 50 例患者，UCP 后中位随访 16 ± 10.2 个月。从 LVAD 植入到重新编程的中位时间为 7 天（IQR 5-9 天）。14 例患者（28%）有潜在的可避免 VA 事件，这些事件将通过其先前的 ICD 编程进行治疗（共 82 例事件，中位数每位患者 2 例，IQR 1-10 例事件）。15 例患者出现了治疗 VA 事件。14 例有潜在可避免 VA 的患者中有 11 例出现了治疗事件。只有 1 例患者报告在潜在可避免事件中出现了明确的自限性“头晕”症状，但未导致住院。没有患者因潜在可避免的 VA 并发症死亡，也不需要紧急护理/住院治疗。
在 LVAD 患者中，UCP 可能在许多患者中避免了不必要的 VA 治疗，且在这些潜在可避免的事件中报告的症状很少。需要前瞻性研究来证实这些发现。
