Korean Circulation Journal

The Korean Society of Cardiology (대한심장학회)
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Tachyarrhythmia Cycle Length in Appropriate versus Inappropriate Defibrillator Shocks in Brugada Syndrome, Early Repolarization Syndrome, or Idiopathic Ventricular Fibrillation

  • Lee, Woo Seok (Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Jun (Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kwon, Chang-Hee (Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Choi, Jin Hee (Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Jo, Uk (Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Yoo Ri (Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Nam, Gi-Byoung (Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Choi, Kee-Joon (Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, You-Ho (Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine)
  • Received : 2015.07.01
  • Accepted : 2015.11.05
  • Published : 2016.03.30
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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) ($mean\;age{\pm}standard\;deviation=42.6{\pm}13.0year$) 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 $178.9{\pm}28.7ms$ and $284.8{\pm}24.4ms$, 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 ${\leq}270ms$, 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 ${\leq}270ms$ in patients with BS, ERS, or IVF could reduce inappropriate ICD shocks, with a low risk of missing appropriate shocks.

Keywords

References

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