心电图变化对皮下植入式心脏除颤器感知过度的临床影响。
Clinical impact of ECG changes on oversensing of subcutaneous implantable cardioverter-defibrillators.
机构信息
Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
出版信息
Heart Rhythm. 2022 Oct;19(10):1704-1711. doi: 10.1016/j.hrthm.2022.05.037. Epub 2022 Jun 7.
BACKGROUND
Inappropriate shocks delivered by subcutaneous implantable cardioverter-defibrillators (S-ICDs) are most frequently caused by cardiac oversensing. However, the predictors for oversensing of S-ICD remain unclear.
OBJECTIVE
We aimed to investigate the predictors for oversensing of S-ICD, especially clinical impact of an electrocardiographic (ECG) change.
METHODS
We retrospectively enrolled 99 consecutive patients who underwent S-ICD implantation between 2013 and 2021. Oversensing events were defined as inappropriate charge of the capacitors induced by cardiac or noncardiac signals other than tachycardia.
RESULTS
During a median follow-up period of 34 months (interquartile range 20-50 months), 11 of 99 patients (11%) experienced 34 oversensing events and 4 patients (4%) received inappropriate shocks during their events. Six patients exhibited ECG changes (bundle branch block, 3; ventricular pacing, 1; inverted T wave, 1; poor R-wave progression, 1) during the follow-up period. Oversensing events were observed in 4 of 6 patients with ECG change (67%), and 3 patients underwent S-ICD removal because of inevitable shock. Contrastingly, of the remaining patients without ECG change, all 7 patients who experienced oversensing events could continue using S-ICD with the reprogramming sensing vector and/or restriction of excessive exercise. Logistic regression analysis showed that lower voltage of Sokolow-Lyon ECG (VS + VR) was the predictor of oversensing in patients without ECG change. When the cutoff value was 2.1 mV, the sensitivity, specificity, positive predictive value, and negative predictive value were 85.7%, 62.7%, 15.7%, and 98.1%, respectively.
CONCLUSION
Unavoidable oversensing resulting in S-ICD removal is caused by ECG change. Oversensing in patients without ECG change can be managed.
背景
皮下植入式心律转复除颤器（S-ICD）引发的不恰当电击最常由心脏过度感知引起。然而，S-ICD 过度感知的预测因素仍不清楚。
目的
我们旨在研究 S-ICD 过度感知的预测因素，特别是心电图（ECG）变化的临床影响。
方法
我们回顾性纳入了 2013 年至 2021 年间接受 S-ICD 植入的 99 例连续患者。过度感知事件定义为除心动过速以外的心脏或非心脏信号引起的电容器的不恰当充电。
结果
在中位随访 34 个月（四分位距 20-50 个月）期间，99 例患者中有 11 例（11%）经历了 34 次过度感知事件，4 例（4%）在事件中接受了不恰当的电击。6 例患者在随访期间出现 ECG 变化（束支传导阻滞，3 例；心室起搏，1 例；T 波倒置，1 例；R 波进展不良，1 例）。在有 ECG 变化的 6 例患者中观察到 4 例（67%）发生过度感知事件，其中 3 例因不可避免的电击而移除了 S-ICD。相比之下，在没有 ECG 变化的其余 7 例患者中，所有 7 例发生过度感知事件的患者均可以通过重新编程感知向量和/或限制过度运动来继续使用 S-ICD。逻辑回归分析表明，无 ECG 变化患者的 Sokolow-Lyon ECG 电压（VS+VR）较低是过度感知的预测因素。当截断值为 2.1 mV 时，敏感性、特异性、阳性预测值和阴性预测值分别为 85.7%、62.7%、15.7%和 98.1%。
结论
导致 S-ICD 移除的不可避免的过度感知是由 ECG 变化引起的。无 ECG 变化患者的过度感知可以得到控制。
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