Arrhythmia Unit, Hospital Universitario Virgen de las Nieves, Avenida de las Fuerzas Armadas, 18014 Granada, Spain.
Biohealth Research Institute ibs. GRANADA, Av. de Madrid, 15, 18012 Granada, Spain.
Europace. 2023 Dec 6;25(12). doi: 10.1093/europace/euad352.
The compatibility of cardiac pacing with the presence of a subcutaneous implantable cardioverter-defibrillator (S-ICD) has been investigated, but S-ICD screening test results have not been compared among different pacing sites. The objective was to compare S-ICD screening results among different cardiac pacing sites and to assess the electrocardiographic predictors of success.
This prospective single-centre study conducted automated S-ICD screening in 102 carriers of cardiac pacing devices in conduction system (CSP), biventricular (BVP), right ventricular outflow tract (RVOT), or right ventricular apex (RVA) pacing sites. The study included 102 patients: 40 with CSP (20 left bundle pacing and 20 His bundle pacing), 21 with BVP, and 20 and 21 with RVOT and RVA pacing, respectively. The percentage of positive screenings was significantly higher for CSP (97.5%) than for the other patient groups (BVP 71.4%, RVOT 70%, and RVA 19%). In multivariate analysis, positive screening was associated with a narrower QRS (OR 0.95 [0.92-0.98] P = 0.001) and higher R/T ratio in precordial leads (1.76 [1.18-2.61]).
A higher S-ICD eligibility rate of cardiac pacing device carriers was obtained in CSP than in conventional pacing (RVA or RVOT) or BVP. The presence of narrower paced QRS width and paced corrected QT interval and of higher R/T ratio in precordial and limb leads are electrocardiographic predictors of a positive response to screening.
已经研究了心脏起搏与皮下植入式心律转复除颤器（S-ICD）共存的兼容性，但尚未比较不同起搏部位的 S-ICD 筛查测试结果。本研究的目的是比较不同心脏起搏部位的 S-ICD 筛查结果，并评估心电图预测成功的指标。
这项前瞻性单中心研究对 102 名携带心脏起搏装置的患者（包括传导系统起搏[CSP]、双心室起搏[BVP]、右心室流出道起搏[RVOT]或右心室心尖部起搏[RVA]）进行了自动 S-ICD 筛查。研究共纳入 102 例患者：40 例为 CSP（20 例左束支起搏，20 例希氏束起搏），21 例为 BVP，20 例和 21 例为 RVOT 和 RVA 起搏。CSP 的阳性筛查率（97.5%）明显高于其他患者组（BVP 为 71.4%，RVOT 为 70%，RVA 为 19%）。多变量分析显示，阳性筛查与较窄的 QRS 波（OR 0.95[0.92-0.98]，P=0.001）和胸前导联较高的 R/T 比值（1.76[1.18-2.61]）相关。
与传统起搏（RVA 或 RVOT）或 BVP 相比，CSP 中的心脏起搏装置携带者的 S-ICD 适宜率更高。较窄的起搏 QRS 宽度和起搏校正 QT 间期以及胸前和肢体导联较高的 R/T 比值是对筛查反应阳性的心电图预测指标。
