Clinical impact of ECG changes on oversensing of subcutaneous implantable cardioverter-defibrillators
Clinical impact of ECG changes on oversensing of subcutaneous implantable cardioverter-defibrillators
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DOI：
10.1016/j.hrthm.2022.05.037
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发表时间：
2022-09-29
期刊：
影响因子：
5.5
通讯作者：
Inomata, Takayuki
中科院分区：
文献类型：
--
作者：
Hakamata, Takahiro;Otsuki, Sou;Inomata, Takayuki
背景：皮下植入式心律转复除颤器（S-ICDs）造成的不适当电击最常见的原因是心脏过度敏感。然而，过度感知S-ICD的预测因素仍不清楚。目的：探讨S-ICD过度敏感的预测因素，特别是心电图变化的临床影响。方法：我们回顾性招募了99例2013年至2021年间连续接受S-ICD植入的患者。超感事件被定义为由心动过速以外的心脏或非心脏信号引起的电容器不适当充电。结果：在34个月的中位随访期间（四分位数范围20-50个月），99例患者中有11例（11%）经历了34次过度敏感事件，4例（4%）患者在事件发生期间接受了不适当的电击。6例患者在随访期间出现心电图改变（束支传导阻滞3例；心室起搏1例；倒T波1例；r波进展不佳1例）。6例心电图改变患者中有4例（67%）出现过敏感事件，3例患者因不可避免的休克而行S-ICD移除。相比之下，其余无心电图改变的患者中，所有7例发生过感测事件的患者均可通过重编程感测载体和/或限制过度运动继续使用S-ICD。Logistic回归分析显示，无心电图变化的患者，较低的Sokolow-Lyon ECG电压（V1S + V5R）是过度敏感的预测因子。截止值为2.1 mV时，敏感性为85.7%，特异性为62.7%，阳性预测值为15.7%，阴性预测值为98.1%。结论不可避免的过感导致S-ICD取出是由心电图改变引起的。无心电图改变的患者的过度敏感是可以控制的。
BACKGROUND Inappropriate shocks delivered by subcutaneous implantable cardioverter-defibrillators (S-ICDs) are most frequently caused by cardiac oversensing. However, the predictors for oversensing of S-ICD remain unclear.OBJECTIVE We aimed to investigate the predictors for oversensing of S-ICD, especially clinical impact of an electrocardiographic (ECG) change.METHODS We retrospectively enrolled 99 consecutive patients who underwent S-ICD implantation between 2013 and 2021. Oversensing events were defined as inappropriate charge of the capacitors induced by cardiac or noncardiac signals other than tachycardia.RESULTS During a median follow-up period of 34 months (interquartile range 20-50 months), 11 of 99 patients (11%) experienced 34 oversensing events and 4 patients (4%) received inappropriate shocks during their events. Six patients exhibited ECG changes (bundle branch block, 3; ventricular pacing, 1; inverted T wave, 1; poor R-wave progression, 1) during the follow-up period. Oversensing events were observed in 4 of 6 patients with ECG change (67%), and 3 patients underwent S-ICD removal because of inevitable shock. Contrastingly, of the remaining patients without ECG change, all 7 patients who experienced oversensing events could continue using S-ICD with the reprogramming sensing vector and/or restriction of excessive exercise. Logistic regression analysis showed that lower voltage of Sokolow-Lyon ECG (V1S + V5R) was the predictor of over-sensing in patients without ECG change. When the cutoff value was 2.1 mV, the sensitivity, specificity, positive predictive value, and negative predictive value were 85.7%, 62.7%, 15.7%, and 98.1%, respectively.CONCLUSION Unavoidable oversensing resulting in S-ICD removal is caused by ECG change. Oversensing in patients without ECG change can be managed.