Tachyarrhythmia Cycle Length in Appropriate versus Inappropriate Defibrillator Shocks in Brugada Syndrome, Early Repolarization Syndrome, or Idiopathic Ventricular Fibrillation
Korean Circulation Journal 2016³â 46±Ç 2È£ p.179 ~ p.185
ÀÌ¿ì¼®(Lee Woo-Seok) - University of Ulsan College of Medicine Asan Medical Center Division of Cardiology
±èÁØ(Kim Jun) - University of Ulsan College of Medicine Asan Medical Center Division of Cardiology
±ÇâÈñ(Kwon Chang-Hee) - University of Ulsan College of Medicine Asan Medical Center Division of Cardiology
ÃÖÁøÈñ(Choi Jin-Hee) - University of Ulsan College of Medicine Asan Medical Center Division of Cardiology
(Jo Uk) - University of Ulsan College of Medicine Asan Medical Center Division of Cardiology
±èÀ¯¸®(Kim Yoo-Ri) - University of Ulsan College of Medicine Asan Medical Center Division of Cardiology
³²±âº´(Nam Gi-Byoung) - University of Ulsan College of Medicine Asan Medical Center Division of Cardiology
ÃÖ±âÁØ(Choi Kee-Joon) - University of Ulsan College of Medicine Asan Medical Center Division of Cardiology
±èÀ¯È£(Kim You-Ho) - University of Ulsan College of Medicine Asan Medical Center Division of Cardiology
Abstract
Background and Objectives: Implantable cardioverter?defibrillators (ICDs) are indicated in patients with Brugada syndrome (BS), early repolarization syndrome (ERS), or idiopathic ventricular fibrillation (IVF) who are at high risk for sudden cardiac death. The optimal ICD programming for reducing inappropriate shocks in these patients remains to be determined. We investigated the difference in the mean cycle length of tachyarrhythmias that activated either appropriate or inappropriate ICD shocks in these three patient groups to determine the optimal ventricular fibrillation (VF) zone for minimizing inappropriate ICD shocks.
Subjects and Methods: We selected 41 patients (35 men) (mean age¡¾standard deviation=42.6¡¾13.0 year) who received ICD shocks between April 1996 and April 2014 to treat BS (n=24), ERS (n=9), or IVF (n=8). Clinical and ICD interrogation data were retrospectively collected and analyzed for all events with ICD shocks.
Results: Of the 244 episodes, 180 (73.8%) shocks were appropriate and 64 (26.2%) were inappropriate. The mean cycle lengths of the tachyarrhythmias that activated appropriate and inappropriate shocks were 178.9¡¾28.7 ms and 284.8¡¾24.4 ms, respectively (p<0.001). The cutoff value with the highest sensitivity and specificity for discriminating between appropriate and inappropriate shocks was 235 ms (sensitivity, 98.4%; specificity, 95.6%). When we programmed a single VF zone of ¡Â270 ms, inappropriate ICD shocks were reduced by 70.5% and appropriate shocks were missed in 1.7% of these patients.
Conclusion: Programming of a single VF zone of ¡Â270 ms in patients with BS, ERS, or IVF could reduce inappropriate ICD shocks, with a low risk of missing appropriate shocks.
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Cardioverter defibrillator, implantable, Brugada syndrome, Ventricular fibrillation
KMID :
0368120160460020179
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À¯È¿¼º°á°ú(Recomendation)
In patients with BS, ERS, or IVF, the mean cycle length of the VF zone is significantly shorter for appropriate shocks than for inappropriate shocks. Programming a single VF zone (¡Â270 ms in patients with BS or as low as ¡Â250 ms in patients with ERS or IVF) might be one method to reduce inappropriate shocks in these patients