Defibrillation Threshold Testing After ICD Implantation in Patients with Chronic Kidney Disease.
IF 3
Q2 CARDIAC & CARDIOVASCULAR SYSTEMS
引用次数: 0
Abstract
Introduction: Routine defibrillation threshold (DFT) testing at the time of implantable cardioverter-defibrillator (ICD) implantation is no longer recommended because testing did not improve shock efficacy or reduce arrhythmic death. However, patients with severe chronic kidney disease (CKD) were not included in these trials and might benefit from DFT testing. International guidelines shed no light on the subject of the effect of kidney function on DFT testing in patients with CKD.
Methods: In this retrospective study, we aimed to identify the success and safety of DFT in patients with CKD stages 1-5 (ages 55-80 years) undergoing primary transvenous ICD implantation.
Results: A total of 451 patients were stratified into three groups based on kidney function: group 1 with CKD stage 1-2 (n = 294), group 2 with CKD stage 3-4 (n = 90), and group 3 with CKD stage 5 (n = 67). Ventricular fibrillation was induced 827 times. The median number of threshold testing per patient was two (interquartile range 1-2; range 1-7). No evidence of between CKD-group differences in ICD defibrillation success rates could be found when using all patient attempts, regardless of correction for energy levels (p = 0.262). DFT-related complications occurred in 16 patients (3.5%), predominantly hypoxemia due to hypoventilation (1.6%) and atrial arrhythmias. Five patients (1.1%) underwent ICD or lead revision following abnormal DFT test results.
Conclusions: We did not demonstrate a correlation between CKD and increased DFT or an increased rate of inadequate defibrillation safety margin. DFT testing is feasible with a low risk of serious complications in patients with moderate and advanced CKD when clinically deemed necessary. DFT testing is not routinely required in patients with (advanced) CKD.
慢性肾病患者ICD植入后除颤阈值测定。
导读：植入式心律转复除颤器（ICD）植入时的常规除颤阈值（DFT）测试不再被推荐，因为测试不能提高休克疗效或减少心律失常死亡。然而，严重慢性肾脏疾病（CKD）患者未纳入这些试验，可能从DFT检测中受益。国际指南没有阐明肾功能对CKD患者DFT检测的影响。方法：在这项回顾性研究中，我们旨在确定DFT在1-5期CKD患者（55-80岁）接受原发性经静脉ICD植入的成功和安全性。结果：451例患者根据肾功能分为三组：1组CKD 1-2期（n = 294）， 2组CKD 3-4期（n = 90）， 3组CKD 5期（n = 67）。诱发心室颤动827次。每位患者阈值检测的中位数为2次(四分位数范围为1-2；范围1 - 7)。当使用所有患者尝试时，没有证据表明ckd组之间的ICD除颤成功率存在差异，无论是否校正能量水平（p = 0.262）。16例（3.5%）患者出现dft相关并发症，主要是低氧血症（1.6%）和心房心律失常。5例患者（1.1%）在DFT检查结果异常后接受了ICD或导联翻修。结论：我们没有证明CKD与DFT增加或除颤安全裕度不足率增加之间的相关性。当临床认为有必要时，DFT检测在中晚期CKD患者严重并发症的低风险下是可行的。（晚期）CKD患者不需要DFT检测。
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来源期刊
Cardiology and Therapy
CARDIAC & CARDIOVASCULAR SYSTEMS-
CiteScore
5.30
自引率
0.00%
发文量
38
审稿时长
6 weeks
期刊介绍：
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Cardiology and Therapy is an international, open access, peer reviewed (single-blind), rapid-publication journal dedicated to the publication of high-quality clinical (all phases), observational, real-world, and health outcomes research around the discovery, development, and use of cardiovascular therapies and interventions, including devices. Studies relating to diagnosis and diagnostics, pharmacoeconomics, public health, quality of life, as well as patient care, management and education are also encouraged.
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