Barold H S, Newby K H, Tomassoni G, Kearney M, Brandon J, Natale A
Electrophysiology Laboratory, Veterans Affairs Medical Center/Duke University Medical Center, Durham, North Carolina, USA.
Pacing Clin Electrophysiol. 1998 Jul;21(7):1347-55. doi: 10.1111/j.1540-8159.1998.tb00204.x.
This study was designed to evaluate the ability to distinguish between supraventricular tachycardias (SVTs) and ventricular tachycardias (VTs) based on onset, stability, and width criteria in an implantable defibrillator. Inappropriate detection of atrial fibrillation and sinus tachycardia is a common problem in patients with implantable defibrillators. The onset, stability, and width criteria were studied in 17 patients who underwent implantation of a Medtronic 7218C implantable defibrillator by inducing sinus tachycardia and atrial fibrillation. Additional data on the width criteria was obtained by pacing at separate sites in both the left and right ventricle. Patients were studied at different times for up to 6 months to determine any changes in the criteria. The onset and stability criteria caused inappropriate detections in 36% and 12% of the episodes, respectively. The addition of the width criteria decreased the inappropriate detection using the onset and stability criteria to 5% and 2%, respectively. Pacing from the RV apex, RV outflow tract, and LV apex was appropriately detected as wide in 76%, 41%, and 94%, respectively. The width criteria changed over time in individual patients, but was stable by 6 months in all but one patient. No single criterion is satisfactory for distinguishing between SVT and VT in this patient population, but the combination of criteria seems to provide better discrimination. The width criteria can change dramatically over time and needs to be monitored carefully. Newer algorithms will need to be developed to allow better detection of supraventricular tachycardias.
本研究旨在评估基于植入式除颤器中的起始、稳定性和宽度标准来区分室上性心动过速（SVT）和室性心动过速（VT）的能力。植入式除颤器患者中，房颤和窦性心动过速的不适当检测是一个常见问题。通过诱发窦性心动过速和房颤，对17例植入美敦力7218C植入式除颤器的患者的起始、稳定性和宽度标准进行了研究。通过在左心室和右心室的不同部位起搏获得了关于宽度标准的额外数据。在长达6个月的不同时间对患者进行研究，以确定标准的任何变化。起始和稳定性标准分别在36%和12%的发作中导致了不适当检测。增加宽度标准后，使用起始和稳定性标准的不适当检测分别降至5%和2%。从右心室心尖、右心室流出道和左心室心尖起搏分别有76%、41%和94%被正确检测为宽。宽度标准在个体患者中随时间变化，但除一名患者外，所有患者在6个月时均稳定。在该患者群体中，没有单一标准能令人满意地区分SVT和VT，但标准的组合似乎能提供更好的鉴别。宽度标准可能随时间发生显著变化，需要仔细监测。需要开发更新的算法以更好地检测室上性心动过速。
