Differences in tachyarrhythmia detection and implantable cardioverter defibrillator therapy by primary or secondary prevention indication in cardiac resynchronization therapy patients
Differences in tachyarrhythmia detection and implantable cardioverter defibrillator therapy by primary or secondary prevention indication in cardiac resynchronization therapy patients
复制标题
DOI：
10.1046/j.1540-8167.2004.03625.x
复制
发表时间：
2004-09-01
影响因子：
2.7
通讯作者：
Abraham, WT
中科院分区：
文献类型：
--
作者：
Wilkoff, BL;Hess, M;Abraham, WT
CRT ICD人群ICD利用差异的研究前言：虽然许多试验表明植入型心脏转复除颤器(ICD)在一级或二级预防中都有好处，但还没有试验前瞻性地招募这两种适应症的患者，并分析了两组之间ICD的利用情况。方法和结果：我们对ICD人群中的心脏再同步治疗(CRT)的随机、前瞻性双盲试验--奇迹ICD进行了回顾。纳入二级预防(N=563)和一级预防(N=415)患者。对室性心动过速(VT)和室颤(VF)发作频率和检测准确性的亚组分析显示，一级预防患者适当发作的频率(0.09vs0.43次/月)明显较低(303+/-54msvs366+/-71ms，P<；0.0001)。这些事件更有可能被设备归类为室颤，并因此接受休克治疗(42%按设备分类，而二级预防为19%，P<；0.0001)。一级预防组月随访不适当发现的绝对率较低，但在所有事件中所占比例高得多(30%对14%，P<；0.0001)。二级预防组中发现最多的是快速传导的房颤；一级预防中的大多数患者是由于窦性心动过速。结论：接受有一级预防指征的ICD治疗的CRT患者与有自发性室速/室颤病史的患者相比，其临床心律失常病程不同。这对ICD的优化规划具有重要意义。对这些差异进行长期、前瞻性的评估是有必要的，应该在更广泛的ICD患者群体中进行调查。
ICD Utilization Differences in the CRT ICD Population. Introduction: Although numerous trials have shown benefit of implantable cardioverter defibrillators (ICDs) for either primary or secondary prevention, no trial has prospectively enrolled patients from both indications and analyzed ICD utilization between groups.Methods and Results: We performed a retrospective review of MIRACLE ICD, a randomized, prospective double-blind trial of cardiac resynchronization therapy (CRT) in the ICD population. Both secondary prevention (N = 563) and primary prevention patients (N = 415) were enrolled. Subgroup analysis for frequency of ventricular tachycardia (VT) and ventricular fibrillation (VF) episodes and detection accuracy revealed that primary prevention patients had a significantly lower frequency of appropriate episodes (0.09 vs 0.43 episodes/month) at significantly faster cycle lengths (303 +/- 54 ms vs 366 +/- 71 ms, P < 0.0001). These episodes were more likely to be classified as VF by the device and thus receive shock therapy (42% by device classification vs 19% in secondary prevention, P < 0.0001). The absolute rate of inappropriate detections in the primary prevention group per month of follow-up was lower but constituted a much higher proportion of all episodes (30% vs 14%, P < 0.0001). Most inappropriate detections in the secondary prevention group were due to rapidly conducted atrial fibrillation; most in the primary prevention patients were due to sinus tachycardia.Conclusion: Patients receiving an ICD for CRT therapy with primary prevention indications have a different clinical arrhythmia course than patients with a history of spontaneous VT/VF. This has implications for the optimal programming of ICDs. Longer-term, prospective evaluation of these differences is warranted and should be investigated in the broader ICD patient population.