SVT discrimination algorithms significantly reduce the rate of inappropriate therapy in the setting of modern-day delayed high-rate detection programming
SVT discrimination algorithms significantly reduce the rate of inappropriate therapy in the setting of modern-day delayed high-rate detection programming
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DOI：
10.1111/jce.14250
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发表时间：
2019-11-05
影响因子：
2.7
通讯作者：
Ellenbogen, Kenneth A.
中科院分区：
文献类型：
--
作者：
Cheng, Alan;Auricchio, Angelo;Ellenbogen, Kenneth A.
背景当代植入性心律转复除颤器(ICD)程序包括延迟高频率检测和使用室上性心动过速(SVT)鉴别器，已显著降低了不适当电击的发生率。仅有SVT算法在多大程度上减少了不适当的治疗，目前还知之甚少。方法和结果无痛SST纳入2770名使用单腔或双腔ICD或心脏再同步除颤器的患者。96%的患者使用SVT辨别器进行了22+/-9个月的随访。持续性室性快速性心律失常和室上性心动过速发作由一个独立的内科委员会裁决。在这项分析中，所有的发作都用SVT鉴别器进行后处理计算机模拟，关闭和不关闭延迟的高频率检测标准(仅限室颤区，在320ms时为30/40)。有3282例被判定的SVT发作，其中115例导致ICD休克，113例仅接受ATP治疗(2年不当休克和治疗率分别为3.1%和4.1%)。对于剩余的3054次SVT发作，治疗被适当地扣留。如果同时关闭SVT判别器和延迟高频率检测，2年不适当治疗的发生率将为22.9%(危险比[HR]=6.24；95%可信区间[CI]：5.20-7.49)。在所有患者中模拟关闭SVT鉴别器和模拟开启延迟高速检测，2年生存率为6.4%(HR=1.63；CI：1.44~1.85)。结论SVT鉴别器的使用在降低ICD治疗不合时率方面具有重要作用，即使在延迟的高检测环境中也是如此。停用SVT鉴别器将导致不适当的ICD治疗率总体上分别增加63%和524%，分别有和没有延迟的高比率检测程序。
Background Contemporary implantable cardioverter-defibrillator (ICD) programming involving delayed high-rate detection and use of supraventricular tachycardia (SVT) discriminators has significantly reduced the rate of inappropriate shocks. The extent to which SVT algorithms alone reduce inappropriate therapies is poorly understood. Methods and Results PainFree SST enrolled 2770 patients with a single- or dual-chamber ICD or cardiac resynchronization defibrillator. Patients were followed for 22 +/- 9 months with SVT discriminators on in 96% of patients. Sustained ventricular tachyarrhythmias and SVT episodes were adjudicated by an independent physician committee. For this analysis, all episodes were subjected to postprocessing computer simulation with SVT discriminators off with and without delayed high-rate detection criteria (ventricular fibrillation zone only, 30/40 at 320 ms). There were 3282 adjudicated SVT episodes of which 115 resulted in an ICD shock and 113 received only ATP (2-year inappropriate shock and therapy rates of 3.1% and 4.1%). Therapy was appropriately withheld for the remaining 3054 SVT episodes. With both SVT discriminators and delayed high-rate detection simulated off, the 2-year inappropriate therapy rate would have been 22.9% (hazard ratio [HR] = 6.24; 95% confidence interval [CI]: 5.20-7.49). With SVT discriminators simulated off and delayed high-rate detection simulated on in all patients, the 2-year rate would have been 6.4% (HR = 1.63; CI: 1.44-1.85). Conclusions The use of SVT discriminators has a significant role in reducing the rate of inappropriate ICD therapy even in the setting of delayed high-rate detection settings. Deactivating SVT discriminators would have resulted in an overall increase in the inappropriate ICD therapy rate by 63% and 524% with and without delayed high-rate detection programming, respectively.