全皮下植入型心律转复除颤器植入术前QRS-T形态筛查通过率及预测因素

Incidents and predictors of pre-implantation QRS-T morphology screening in subcutaneous implantable cardioverter defibrillator

目的本文旨在研究在植入全皮下植入型心律转复除颤器（subcutaneous implantable car-diovertcr defibrillator，SICD）进行模拟心电图QRS-T形态筛查（a pre-implantation QRS-T morphology screening，TMS）的通过率及筛选失败的影响因素。方法2016年5月至10月从复旦大学附属中山医院住院及门诊患者中筛查80例具有ICD适应证的患者，包括已植入经静脉ICD（tansvenous implantable cardioverter defibrillator，TV-ICD），排除起搏依赖患者。利用厂家程控器对这些患者进行SICD相应3个向量的描记并得出心电图（TMS-ECG），同时进行筛选。当TMS-ECG中至少1个向量同时在卧位、坐位、站位均通过模具筛查，则被视为通过并比较通过筛查与未通过患者的临床特点、超声心动图、心电图参数差异。结果TMS通过率为91．2％，7例（8．8％）患者未通过筛查。测试时将电极放置于胸骨左侧时，有7例患者未通过筛查，后将3例患者的测试电极放置于胸骨右侧后，有1例患者通过筛查。常规12导联中宽QRS时限（≥150ms）是TMS筛查失败的预测因子。结论在筛查SICD患者时仍需谨慎，因为有少部分患者（尤其合并宽QRS时限）的心电波形可能无法被SICD适当感知。

Objective To study the incidents of pre-implantation QRS-T morphology screening（TMS） in subcutaneous implantable cardioverter defibrillator（ SICD）-eligible Chinese patients and predictors for TMS ineligible patients. Methods TMS was conducted in 80 consecutive outpatients and inpatients [ 83.8% male, age （ 57 ± 13 ） years ] who already had tansvenous implantable cardioverter defibrillators （TV-ICD） or needed ICD for primary or secondary preventions in Zhongshan Hospital,without an indication for cardiac pacing or accep- ting cardiac resynchronization therapy, using an ECG simulating the 3 sensing vectors of the SICD （TMS-ECG）. Patients were defined suitable when at least 1 sensing vector was considered appropriate in supine, squat and standing position. Clinical, echocardiographic and standard ECG characteristics of patients who failed the test were compared to those who passed. Results In total,91.2% of patients were eligible for a SICD,8.8% of patients were considered not eligible according to the TMS-ECG. Seven patients failed TMS-ECG with the con- ventional left parasternal electrode configuration in all three subcutaneous ECG vectors, and one of them passed the TMS-ECG with the conventional right parasternal electrode configuration. Only the prolong QRS duration（ ≥ 150 ms,OR=0. 017,95% CI O. 001-0. 416）was the independent predictors of failure in TMS. Conclusions We should be in special caution when selecting patients for SICD, especially the patients with wide QRSd, be- cause their ECG may not be adequately sensed by SICD.