Biffi Mauro, Statuto Giovanni, Calvi Valeria, Iori Matteo, De Maria Elia, Bolognesi Maria Giulia, Allocca Giuseppe, Notarangelo Francesca, Carinci Valeria, Ammendola Ernesto, Boggian Giulio, Saporito Davide, Mancini Luigi, Potenza Domenico, Celentano Eduardo, Giorgi Davide, Ziacchi Matteo
Institute of Cardiology, University of Bologna, S. Orsola-Malpighi University Hospital, Bologna, Italy.
Institute of Cardiology, University of Bologna, S. Orsola-Malpighi University Hospital, Bologna, Italy.
Heart Rhythm. 2025 Jul;22(7):e141-e148. doi: 10.1016/j.hrthm.2024.10.004. Epub 2024 Oct 5.
In patients with implantable cardioverter-defibrillators (ICDs), inappropriate therapies (ITs) are often caused by supraventricular tachyarrhythmias (SVTs).
We aimed to estimate the incidence of IT in modern single-lead ICDs.
The THINGS study enrolled patients with single-lead ICDs with 2 SVT discrimination modalities: dual chamber (DC) with an atrial floating dipole or single chamber (SC) with morphology criterion. All devices were programmed with 2-zone therapy: ventricular tachycardia (VT) zone from 170 beats/min with ≥15 seconds (≥36 beats) detection time and SVT discriminators; and ventricular fibrillation (VF) zone from 214 beats/min with ≥7 seconds (≥24 beats) detection time. The primary end point was the first occurrence of IT, adjudicated by an independent board.
A total of 526 patients (median age, 66 years; 83% male), 183 (34.8%) with DC and 343 (65.2%) with SC discrimination, were observed for a median of 2.2 years. The incidence rate of IT was 4.2% (95% confidence interval [CI], 2.7%-6.4%) at 1 year and 7.1% (95% CI, 5.0%-9.9%) at 2 years. Younger age (adjusted hazard ratio, 0.97; 95% CI, 0.95-0.99; P = .013) and history of atrial fibrillation (adjusted hazard ratio, 2.67; 95% CI, 1.30-5.46; P = .007) were significantly associated with increased IT risk. In a propensity score-matched comparison, DC discrimination showed a trend toward reduced IT rates compared with SC discrimination in the VT zone (1-year incidence, 1.8% vs 3.5%; P = .105).
High-rate VF cutoff and prolonged detection time programming resulted in a low IT rate in single-lead ICD patients with modern SVT discriminators. A trend favoring the DC system was observed in the VT zone.
在植入式心脏复律除颤器（ICD）患者中，不适当治疗（IT）常由室上性快速心律失常（SVT）引起。
我们旨在评估现代单腔ICD中IT的发生率。
THINGS研究纳入了具有两种SVT鉴别模式的单腔ICD患者：带有心房漂浮偶极的双腔（DC）模式或具有形态学标准的单腔（SC）模式。所有设备均采用双区治疗编程：室性心动过速（VT）区为心率170次/分钟，检测时间≥15秒（≥36次搏动），以及SVT鉴别器；室颤（VF）区为心率214次/分钟，检测时间≥7秒（≥24次搏动）。主要终点是由独立委员会判定的首次发生IT。
共观察了526例患者（中位年龄66岁；83%为男性），其中183例（34.8%）采用DC鉴别模式，343例（65.2%）采用SC鉴别模式，中位观察时间为2.2年。IT的发生率在1年时为4.2%（95%置信区间[CI]，2.7%-6.4%），在2年时为7.1%（95%CI，5.0%-9.9%）。年龄较小（校正风险比，0.97；95%CI，0.95-0.99；P = 0.013）和房颤病史（校正风险比，2.67；95%CI，1.30-5.46；P = 0.007）与IT风险增加显著相关。在倾向评分匹配比较中，与SC鉴别模式相比，DC鉴别模式在VT区显示出IT发生率降低的趋势（1年发生率，1.8%对3.5%；P = 0.105）。
高心率VF截止值和延长检测时间编程导致具有现代SVT鉴别器的单腔ICD患者中IT发生率较低。在VT区观察到有利于DC系统的趋势。
