通过静脉和皮下植入式除器中适当的冲击和抗心动减速器的有效性和安全性:PRAETORIAN试验中所有适当治疗的分析
Reinoud E Knops1, Willeke van der Stuijt1, Peter Paul H M Delnoy2
1Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, location AMC, The Netherlands (R.E.K., W.v.d.S., L.V.A.B., T.F.B., A.-F.B.E.Q., L.S., J.G.P.T., J.R.d.G., K.M.K., A.d.W., A.A.M.W., L.R.A.O.N.).
Circulation
|November 15, 2021
概括
皮下植入式心脏转动器 (S- ICD) 与输血式心脏转动器 (TV- ICD) 相比,显示出相似的适当治疗. 然而,S-ICD患者受到的电击更多,尽管电风风险较低.
科学领域:
- 心脏病学
- 医疗器械
- 临床试验
背景情况:
- 在PRAETORIAN试验中,比较了皮下植入式心脏转动器 (S- ICD) 和静脉输入式心脏转动器 (TV- ICD) 系统.
- S-ICD提供了TV-ICD的替代方案,但缺乏单体心室动脉冲动 (ATP).
- 这项分析的重点是适当的治疗和ATP在减轻冲击中的作用.
研究的目的:
- 在S-ICD和TV-ICD中评估适当的ICD治疗.
- 要确定抗心动节奏 (ATP) 是否会影响适当的冲击次数.
- 为了比较S-ICD和TV-ICD之间的冲击效率和电暴发生率.
主要方法:
- 在PRAETORIAN试验中,有849名患者被随机分配到S- ICD或TV- ICD.
- 随访时间中位数为49. 1个月,具有强制性的ICD编程.
- 对心室节律失常的适当ICD疗法进行了分析,将发作分类为离散或风暴事件.
主要成果:
- 在S- ICD和TV- ICD组之间没有显著的治疗差异 (19. 4% vs.
- 在S- ICD患者中,至少发生一次冲击的可能性更高 (19. 2% vs 11. 5%),但总冲击和第一次冲击的疗效相似.
- ATP终止了46%的单态VT,但加速了9.4%;S-ICD组的电风暴风险较低.
结论:
- 与TV- ICD相比,S- ICD在适当的治疗中显示出非劣势.
- 虽然S- ICD患者接受了更多的冲击,但适当冲击的总数和冲击疗效是可比的.
- S-ICD系统可能与较低的电风风险有关.
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