Clinical Cardiovascular Research Center, Department of Medicine, University of Rochester Medical Center, Rochester, New York.
Clinical Cardiovascular Research Center, Department of Medicine, University of Rochester Medical Center, Rochester, New York.
Am J Cardiol. 2022 Nov 1;182:32-39. doi: 10.1016/j.amjcard.2022.07.018. Epub 2022 Sep 6.
The Multicenter Automatic Defibrillator Implantation Trial - Reduce Inappropriate Therapy showed a significant reduction in the risk of inappropriate therapy in patients with a programmed high-rate cutoff ≥200 beats per minute or delayed therapy for events ≥170 beats per minute compared with conventional programming. We aimed to characterize outcomes by left ventricular ejection fraction (LVEF) ranges for patients with high-rate, delayed, or conventional implantable cardioverter-defibrillator programming. We assessed the effect of LVEF (LVEF <15%, LVEF 15% to 25%, LVEF >25%) on the risk of inappropriate conventional implantable cardioverter-defibrillator therapy and death in Multicenter Automatic Defibrillator Implantation Trial - Reduce Inappropriate Therapy. Inappropriate therapies and death were independently evaluated by the adjudication committee. Statistical methods involved Kaplan-Meier time-to-event graphs and Cox proportional hazards regression analyses. The study involved 140 patients (9%) with LVEF 15%, 585 with LVEF 15% to 25% (39%), and 774 with LVEF >25% (52%). High-rate or delayed programming significantly reduced the risk of inappropriate therapy compared with conventional programming in patients with all LVEFs (p <0.001 for all LVEF). Patients with LVEF <15% had an exceptional 97% lower risk of inappropriate therapy, with high-rate programming than conventional programming (hazard ratio 0.028, p = 0.001), without an increase in mortality. High-rate and delayed programming is superior to conventional programming in all LVEF ranges, without adverse effects.
多中心自动除颤器植入试验-减少不适当治疗显示，与传统程控相比，程控高心率截止≥200 次/分或延迟治疗事件≥170 次/分的患者，不适当治疗的风险显著降低。我们旨在通过高心率、延迟或常规植入型心律转复除颤器程控患者的左心室射血分数（LVEF）范围来描述结果。我们评估了 LVEF（LVEF <15%、LVEF 15%-25%、LVEF >25%）对 Multicenter Automatic Defibrillator Implantation Trial - Reduce Inappropriate Therapy 中不适当常规植入型心律转复除颤器治疗和死亡风险的影响。不适当治疗和死亡由裁决委员会独立评估。统计方法涉及 Kaplan-Meier 时间事件图和 Cox 比例风险回归分析。该研究涉及 140 名 LVEF 为 15%的患者（9%）、585 名 LVEF 为 15%-25%的患者（39%）和 774 名 LVEF >25%的患者（52%）。与传统程控相比，高心率或延迟程控在所有 LVEF 患者中显著降低了不适当治疗的风险（所有 LVEF 均 <0.001）。与传统程控相比，LVEF <15%的患者不适当治疗的风险降低了 97%（风险比 0.028，p=0.001），而死亡率没有增加。高心率和延迟程控在所有 LVEF 范围内均优于传统程控，没有不良影响。
