在LVAD患者中,适当和不适当的ICD冲击:患病率,相关因素和病因
Andrew Andreae1, Eric Black-Maier2, Kelly Arps1
1Division of Electrophysiology, Duke University Medical Center, Durham, North Carolina.
在左心室辅助器 (LVAD) 植入后,植入式心脏转换器-除器 (ICD) 冲击是常见的. 脑上心室节律失常常常会导致不适当的冲击,需要对LVAD患者进行优化的ICD编程.
科学领域:
- 心脏病学 心脏病学
- 医疗器械 医疗器械
- 电子生理学 电子生理学
背景情况:
- 植入式心脏转换器-除器 (ICD) 对于控制心律失常至关重要.
- 来自ICD的冲击是左心室辅助器件 (LVAD) 植入后的一个已知的并发症.
- 关于LVAD接受者的ICD冲击的频率和具体原因的数据有限.
研究的目的:
- 为了确定LVAD患者中ICD冲击的发生率.
- 分析与冲击相关的ICD编程特征.
- 为了确定患者的因素,有助于适当和不适当的ICD冲击在LVAD接受者.
主要方法:
- 在杜克大学医院 (2013-2019) 进行了LVAD接受者与先前存在的内科疾病的回顾性审查.
- 治疗医生和第二名审查员对ICD冲击的判断.
- 分析器械病史和患者特征.
主要成果:
- 在421名LVAD患者中,有147名 (33.9%) 患者在植入后至少经历过一次ICD冲击.
- 分析了330个冲击事件:77.3%是适当的,22.7%是不适当的.
- 上心动 (20.0%) 和过度感应 (2.7%) 是不适当冲击的主要原因;LVAD EMI是罕见的 (0.3%).
结论:
- 在LVAD接受者中,不适当的ICD冲击很常见,主要是由于心室上节律失常.
- 建议优化ICD编程,包括更长的检测延迟和更高的速率切断.
- 目前美国心脏协会对LVAD编程的指导方针可能会减少不适当的冲击.
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