Weber M, Block M, Brunn J, Bänsch D, Böcker D, Hammel D, Gietzen F, Breithardt G
Medizinische Klinik und Poliklinik, Westfälische Wilhelms-Universität Münster.
Z Kardiol. 1996 Nov;85(11):809-19.
Patients with implantable cardioverter defibrillators (ICD) often suffer inappropriate ICD-therapies. The incidence, causes and risk factors of ICD-therapies for a rhythm other than ventricular tachyarrhythmias (VT) were determined retrospectively in 462 consecutive patients (pts). Inappropriate ICD-therapies were identified based on stored R-R intervals and/or electrograms. Eighty-two pts (18%) had inappropriate ICD-therapies. Actuarial rates for inappropriate ICD-therapies were 13%, 20%, 24% and 29% at 1, 2, 3 and 4 years after ICD-implantation, respectively. Atrial fibrillation with rapid ventricular response was the most common cause (34 pts, 39%). In 26 pts (30%), sinus tachycardia triggered inappropriate ICD-therapies, in 21 pts (24%) overseeing, mostly due to fractures and insulation failures of the leads, in three pts atrial flutter, in two pts non-sustained VT, in one pt supra-ventricular tachycardia and in another pt T-wave double sensing caused inappropriate ICD-therapies. In order to prevent recurrences of inappropriate ICD-therapies due to atrial fibrillation or sinus tachycardia, a rate stability (n = 19) or onset (n = 15) criterion was programmed, 41 pts additionally received beta-blocking agents and/or digoxin. In pts with overseeing an operative revision of lead system was performed. During further follow-up (15 +/- 13 months), 15 pts had recurrences of inappropriate ICD-therapies (eight pts due to atrial fibrillation, three due to sinus tachycardia and four due to overseeing). On multivariate analysis (Cox regression), history of atrial fibrillation, maximum heart rate during exercise and low cut-off rate for VT-detection were predictors of inappropriate ICD-therapies. Thus, inappropriate ICD-therapies are frequent, especially in the first year after implantation. Additional detection criteria, beta-blocking agents and/or digoxin prevent recurrences in most patients. In patients with a history of atrial fibrillation, high heart rate during exercise or a low cut-off rate for VT-detection, activation of additional detection criteria should be considered directly after ICD-implantation.
植入式心脏复律除颤器（ICD）患者常遭受不适当的ICD治疗。对462例连续患者回顾性确定了非室性快速心律失常（VT）节律的ICD治疗的发生率、原因和危险因素。基于存储的R-R间期和/或心电图确定不适当的ICD治疗。82例患者（18%）接受了不适当的ICD治疗。ICD植入后1、2、3和4年时，不适当ICD治疗的精算发生率分别为13%、20%、24%和29%。伴有快速心室反应的心房颤动是最常见原因（34例，39%）。26例患者（30%）因窦性心动过速触发不适当的ICD治疗，21例患者（24%）因监测失误触发，主要由于导线骨折和绝缘故障，3例患者因心房扑动，2例患者因非持续性VT，1例患者因室上性心动过速，另1例患者因T波双重感知触发不适当的ICD治疗。为预防因心房颤动或窦性心动过速导致的不适当ICD治疗复发，设置了心率稳定性（n = 19）或起始标准（n = 15），41例患者额外接受了β受体阻滞剂和/或地高辛。对监测失误的患者进行了导线系统的手术修复。在进一步随访（15±13个月）期间，15例患者再次出现不适当的ICD治疗（8例因心房颤动，3例因窦性心动过速，4例因监测失误）。多因素分析（Cox回归）显示，心房颤动病史、运动时最大心率和VT检测的低截止心率是不适当ICD治疗的预测因素。因此，不适当的ICD治疗很常见，尤其是在植入后的第一年。额外的检测标准、β受体阻滞剂和/或地高辛可预防大多数患者复发。对于有心房颤动病史、运动时心率高或VT检测截止心率低的患者，应在ICD植入后直接考虑激活额外的检测标准。
