Cardiac Rhythm Management Research Department, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom; Faculty of Medicine, University of Southampton, Southampton, United Kingdom.
Faculty of Medicine, University of Southampton, Southampton, United Kingdom; Cardiac Rhythm Management, Boston Scientific, Marlborough, MA, USA.
J Electrocardiol. 2022 May-Jun;72:21-27. doi: 10.1016/j.jelectrocard.2022.02.008. Epub 2022 Feb 23.
Haemodialysis patients who require defibrillator therapy are expected to benefit from the entirely avascular subcutaneous defibrillator (S-ICD), but haemodialysis is associated with dynamic changes in R and T wave amplitude which can impact S-ICD eligibility. A continuous assessment of S-ICD eligibility during haemodialysis has not previously been performed.
Continuous surface ECG recordings were obtained from a cohort of patients undergoing maintenance haemodialysis, but without an indication for an ICD. Automated vector screening was retrospectively performed at one-minute intervals throughout the dialysis session. Variations in S-ICD eligibility were calculated and in vectors with high degrees of variation, the underlying mechanism was identified.
72 vector recordings (mean duration 254.1 ± 6.0 min) were obtained from 24 patients (mean age 64.3 ± 5.5 years, 68% male). At the start of haemodialysis 47 vectors were S-ICD eligible (65.2%). At the end of session, all of these vectors had remained eligible, and an additional 6 vectors had also become eligible (73.6%). High vector score variability was observed in 7 patients and the commonest cause was a progressive change in R:T ratio (71.5%).
In a haemodialysis population, a single haemodialysis session can be associated with a potential change in S-ICD eligibility in 8.4% of vectors, with up to 12.5% of vectors showing high degrees of variability, most commonly due to variations in R:T ratio. In an S-ICD population with similar characteristics S-ICD screening prior to haemodialysis would be expected to more accurately identify vectors that retain eligibility.
需要除颤器治疗的血液透析患者有望从完全无血管的皮下除颤器（S-ICD）中获益，但血液透析会导致 R 波和 T 波振幅发生动态变化，从而影响 S-ICD 的适应证。以前尚未对血液透析过程中的 S-ICD 适应证进行连续评估。
从接受维持性血液透析但没有 ICD 适应证的患者中连续获得体表心电图记录。在透析过程中，以一分钟的间隔回顾性地进行自动向量筛查。计算 S-ICD 适应证的变化，并在具有高变化程度的向量中，确定潜在机制。
从 24 例患者中获得 72 个向量记录（平均持续时间 254.1±6.0 分钟）（平均年龄 64.3±5.5 岁，68%为男性）。在血液透析开始时，47 个向量符合 S-ICD 适应证（65.2%）。在治疗结束时，所有这些向量仍然符合适应证，另外 6 个向量也符合适应证（73.6%）。在 7 例患者中观察到高向量评分变化，最常见的原因是 R:T 比值逐渐变化（71.5%）。
在血液透析人群中，单次血液透析治疗可能导致 8.4%的向量的 S-ICD 适应证发生潜在变化，多达 12.5%的向量表现出高度变化，最常见的原因是 R:T 比值变化。在具有类似特征的 S-ICD 人群中，在血液透析前进行 S-ICD 筛查预计将更准确地识别保留适应证的向量。
