单中心评估除颤阈值对全皮下植入型心律转复除颤器放电事件的预测价值  

Single center evaluation of the value of defibrillation threshold in predicting discharge events of total subcutaneous implantable cardioverter defibrillator

作　　者：韩亚凡 汤宝鹏[1] 王菲菲 周贤惠[1] 张疆华[1] 邢强[1] 祖克拉·吐尔洪 芦颜美[1] 张玲[1] 李耀东[1] Han Yafan;Tang Baopeng;Wang Feifei;Zhou Xianhui;Zhang Jianghua;Xing Qiang;Zukela Tuerhong;Lu Yanmei;Zhang Ling;Li Yaodong(Department of Pacing and Electrophysiology,Department of Cardiac Electrophysiology and Remodeling,The First Affiliated Hospital of Xinjiang Medical University,Urumqi 830054,China)

机构地区：[1]新疆医科大学第一附属医院心脏中心起搏电生理科新疆心电生理与心脏重塑重点实验室,乌鲁木齐830054

出　　处：《中华心律失常学杂志》2022年第4期355-359,共5页Chinese Journal of Cardiac Arrhythmias

基　　金：国家自然科学基金(81873487,81670292)。

摘　　要：目的探讨全皮下植入型心律转复除颤器(S-ICD)植入术中除颤阈值(DFT)测试对后期放电事件的预测价值。方法选择2017年1月至2021年6月在新疆医科大学第一附属医院植入S-ICD并至少随访3个月的患者,按照术中有无DFT测试及PRAETORIAN评分分为DFT测试组、DFT未测试组,PRAETORIAN评分≤45分组、>45分组。回顾性收集患者一般资料并分析其临床特点、放电事件和并发症等。初步探讨DFT测试对后期放电事件的预测价值,以及复律失败风险极低患者的不恰当放电概率是否随PRAETORIAN评分的增高而增大。结果研究纳入41例患者,其中男31例,年龄(54.9±15.0)岁,年龄范围18~85岁。所有患者均未出现术后并发症。中位随访4个月内,10例患者发生37次放电事件。DFT测试组与DFT未测试组不恰当放电患者数(1对1,P=1.000)及不恰当放电总次数(10对1,P=0.064)差异无统计学意义。PRAETORIAN评分≤45分组与>45分组不恰当放电患者数差异无统计学意义(0对2,P=0.133),不恰当放电总次数差异具有统计学意义(0对11,P<0.001)。结论S-ICD植入术中DFT测试对患者后期放电事件影响较小。复律失败风险极低患者的PRAETORIAN评分越高,不恰当放电可能性越大,该结论有待扩大样本量加以确认。Objective To investigate the predictive value of the intraoperative defibrillation threshold(DFT)in late discharge events during the fully subcutaneous implantable cardioverter defibrillator(S-ICD)implantation.Methods The patients who received S-ICD implantation in the First Affiliated Hospital of Xinjiang Medical University,and followed up for at least 3 months from January 2017 to June 2021,were enrolled.Patients were divided into DFT test group,non-DFT test group,PRAETORIAN score≤45 group,and>45 group,according to whether intraoperative DFT test and PRAETORIAN score were performed.The general data of the patients were collected retrospectively,and their clinical features,discharge events,and complications were analyzed.To explore the predictive value of DFT test for later discharge events,and whether the probability of inappropriate discharge in patients with extremely very low risk of cardioversion failure increases with the increase of PRAETORIAN score.Results A total of 41 patients were selected in the study,with an average age of(54.9±15.0)years(18-85 years).All patients had no postoperative complications.In a median follow-up of 4 months,a total of 37 discharge events occurred in 10 patients.There was no significant difference in the number of patients with inappropriate discharge(1 vs.1,P=1.000),and the total number of inappropriate discharge(10 vs.1,P=0.064)between the DFT test group and the non-DFT test group.There was no significant difference in the number of patients with inappropriate discharge(0 vs.2,P=0.013)between PRAETORIAN score≤45 and>45,but there was significant difference in total number of inappropriate discharge(0 vs.11,P<0.001).Conclusion The DFT test during S-ICD implantation has little effect on the patient’s later discharge events.The higher the PRAETORIAN score of patients with very low risk of cardioversion failure,the higher the possibility of inappropriate discharge.The conclusion needs to be confirmed by further expanding the sample size.

关 键 词：除颤器 植入型 全皮下 除颤阈值 不恰当放电 PRAETORIAN评分 

分 类 号：R541.7[医药卫生—心血管疾病]