Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental Cardiology, IRCCS Fondazione Policlinico S. Matteo, Viale Camillo Golgi, 19, 27100 Pavia, Italy.
Cardiology Unit, Azienda Ospedaliera Universitaria Pisana, via Paradisa, 2, 56123 Pisa, Italy.
Europace. 2023 May 19;25(5). doi: 10.1093/europace/euac234.
In subcutaneous implantable cardioverter defibrillator (S-ICD) recipients, the UNTOUCHED study demonstrated a very low inappropriate shock rate on programming a conditional zone between 200 and 250 bpm and a shock zone for arrhythmias >250 bpm. The extent to which this programming approach is adopted in clinical practice is still unknown, as is its impact on the rates of inappropriate and appropriate therapies.
We assessed ICD programming on implantation and during follow-up in a cohort of 1468 consecutive S-ICD recipients in 56 Italian centres. We also measured the occurrence of inappropriate and appropriate shocks during follow-up. On implantation, the median programmed conditional zone cut-off was set to 200 bpm (IQR: 200-220) and the shock zone cut-off was 230 bpm (IQR: 210-250). During follow-up, the conditional zone cut-off rate was not significantly changed, while the shock zone cut-off was changed in 622 (42%) patients and the median value increased to 250 bpm (IQR: 230-250) (P < 0.001). UNTOUCHED-like programming of detection cut-offs was adopted in 426 (29%) patients immediately after device implantation, and in 714 (49%, P < 0.001) at the last follow-up. UNTOUCHED-like programming was independently associated with fewer inappropriate shocks (hazard ratio 0.50, 95%CI 0.25-0.98, P = 0.044), and had no impact on appropriate and ineffective shocks.
In recent years, S-ICD implanting centres have increasingly programmed high arrhythmia detection cut-off rates, at the time of implantation in the case of new S-ICD recipients, and during follow-up in the case of pre-existing implants. This has contributed significantly to reducing the incidence of inappropriate shocks in clinical practice. Rordorf: Programming of the S-ICD.
URL: http://clinicaltrials.gov/Identifier: NCT02275637.
在皮下植入式心律转复除颤器（S-ICD）受者中，UNTOUCHED 研究表明，在编程 200-250bpm 之间的条件区域和 >250bpm 的心律失常区域时，非常低的不适当电击率。这种编程方法在临床实践中的采用程度仍不清楚，其对不适当和适当治疗的影响也不清楚。
我们评估了 56 家意大利中心的 1468 例连续 S-ICD 受者的植入和随访期间的 ICD 编程。我们还测量了随访期间不适当和适当电击的发生情况。植入时，中位程控条件区截止值设定为 200bpm（IQR：200-220），电击区截止值设定为 230bpm（IQR：210-250）。随访期间，条件区截止值率无显著变化，而电击区截止值在 622 例（42%）患者中发生变化，中位数增加至 250bpm（IQR：230-250）（P<0.001）。植入后即刻，426 例（29%）患者采用 UNTOUCHED 样检测截止值编程，714 例（49%，P<0.001）在最后一次随访时采用 UNTOUCHED 样编程。UNTOUCHED 样编程与较少的不适当电击相关（风险比 0.50，95%CI 0.25-0.98，P=0.044），对适当和无效电击无影响。
近年来，S-ICD 植入中心在新植入 S-ICD 受者植入时，以及在预植入受者随访时，越来越多地编程高心律失常检测截止值，这显著降低了临床实践中不适当电击的发生率。
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