Dynamic analysis of cardiac rhythms for discriminating atrial fibrillation from lethal ventricular arrhythmias.
Dynamic analysis of cardiac rhythms for discriminating atrial fibrillation from lethal ventricular arrhythmias.
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DOI：
10.1161/circep.113.000034
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发表时间：
2013-06
期刊：
影响因子：
--
通讯作者：
Moorman JR
中科院分区：
文献类型：
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作者：
DeMazumder D;Lake DE;Cheng A;Moss TJ;Guallar E;Weiss RG;Jones SR;Tomaselli GF;Moorman JR
植入式心脏复律除颤器 (ICD) 是预防高危患者心源性猝死的一线治疗方法，可提供适当的电击以终止室性心动过速 (VT)/心室颤动。 ICD 的一个常见缺点是心律识别不完善，导致对心房颤动 (AF) 产生不适当的电击。心律辨别的一个尚未充分探索的领域是 AF 和 VT/心室颤动之间动态特性的差异。我们假设 ICD 电击前快速心律的熵较高，可将 AF 与 VT/心室颤动区分开来。在一项对使用一级预防 ICD 的患者进行的多中心、前瞻性、观察性研究中，119 名患者接受了 ICD 电击，并保存了可检索的心内电图。盲法裁决显示，对 VT/室颤 (62%)、AF (23%) 和室上性心动过速 (15%) 进行了电击。 ICD 电击前仅 9 个心室间隔的熵估计可以准确区分 AF（接收器工作特征曲线面积，0.98；95% 置信区间，0.93–1.0），并且优于当代 ICD 心律辨别算法。这种基于熵估计的房颤辨别新策略扩展了更简单的变异性概念，在快心率下表现良好，并且具有广泛的临床应用潜力。
Implantable cardioverter-defibrillators (ICDs), the first line of therapy for preventing sudden cardiac death in high-risk patients, deliver appropriate shocks for termination of ventricular tachycardia (VT)/ventricular fibrillation. A common shortcoming of ICDs is imperfect rhythm discrimination, resulting in the delivery of inappropriate shocks for atrial fibrillation (AF). An underexplored area for rhythm discrimination is the difference in dynamic properties between AF and VT/ventricular fibrillation. We hypothesized that the higher entropy of rapid cardiac rhythms preceding ICD shocks distinguishes AF from VT/ventricular fibrillation. In a multicenter, prospective, observational study of patients with primary prevention ICDs, 119 patients received shocks from ICDs with stored, retrievable intracardiac electrograms. Blinded adjudication revealed shocks were delivered for VT/ventricular fibrillation (62%), AF (23%), and supraventricular tachycardia (15%). Entropy estimation of only 9 ventricular intervals before ICD shocks accurately distinguished AF (receiver operating characteristic curve area, 0.98; 95% confidence intervals, 0.93–1.0) and outperformed contemporary ICD rhythm discrimination algorithms. This new strategy for AF discrimination based on entropy estimation expands on simpler concepts of variability, performs well at fast heart rates, and has potential for broad clinical application.