Grimm Wolfram, Hoffmann J J ürgen, Müller Hans Helge, Maisch Bernhard
Department of Cardiology, Hospital of the Philipps-University of Marburg, Marburg, Germany.
J Am Coll Cardiol. 2002 Mar 6;39(5):780-7. doi: 10.1016/s0735-1097(01)01822-8.
This study investigated the incidence of appropriate implantable cardioverter defibrillator (ICD) interventions for ventricular tachycardia (VT) or ventricular fibrillation (VF) in patients with idiopathic dilated cardiomyopathy (IDC) and nonsustained VT in the presence of a left ventricular ejection fraction below 30%, versus in patients with syncope and patients with a history of VT or VF.
To date, only limited information is available about the prophylactic use of ICDs in patients with IDC.
From January 1993 to July 2000, 101 patients with IDC underwent implantation of ICDs with electrogram storage capability at our institution. Patients were placed into one of three groups according to their clinical presentation: asymptomatic or mildly symptomatic nonsustained VT in the presence of a left ventricular ejection fraction < or = 30% (49 patients, prophylactic group), unexplained syncope or near syncope (26 patients, syncope group) and a history of sustained VT or VF (26 patients, VT/VF group).
During 36 +/- 22 months follow-up, 18 of 49 patients (37%) in the prophylactic group received appropriate shocks for VT or VF, compared with 8 of 26 patients (31%) in the syncope group and with 9 of 26 patients (35%) of the VT/VF group. Multivariate Cox analysis of baseline clinical variables identified left ventricular ejection fraction, atrial fibrillation and a history of sustained VT or VF as predictors for appropriate ICD interventions during follow-up.
Patients with IDC and prophylactic ICD implantation for nonsustained VT in the presence of a left ventricular ejection fraction < or = 30% had an incidence of appropriate ICD interventions similar to that of patients with a history of syncope or sustained VT or VF. These findings indicate that ICDs may have a role in not only secondary but also primary prevention of sudden death in IDC.
本研究调查了在左心室射血分数低于30%且存在非持续性室性心动过速（VT）的特发性扩张型心肌病（IDC）患者中，与晕厥患者以及有VT或室颤（VF）病史的患者相比，植入式心脏复律除颤器（ICD）对VT或VF进行恰当干预的发生率。
迄今为止，关于ICD在IDC患者中的预防性应用仅有有限的信息。
从1993年1月至2000年7月，101例IDC患者在我们机构接受了具有心电图存储功能的ICD植入。根据临床表现，患者被分为三组之一：左心室射血分数≤30%时无症状或轻度症状性非持续性VT（49例患者，预防组）、不明原因晕厥或接近晕厥（26例患者，晕厥组）以及有持续性VT或VF病史（26例患者，VT/VF组）。
在36±22个月的随访期间，预防组49例患者中有18例（37%）因VT或VF接受了恰当电击，晕厥组26例患者中有8例（31%），VT/VF组26例患者中有9例（35%）。对基线临床变量进行多变量Cox分析发现，左心室射血分数、房颤以及有持续性VT或VF病史是随访期间ICD恰当干预的预测因素。
左心室射血分数≤30%且因非持续性VT植入预防性ICD的IDC患者，其ICD恰当干预的发生率与有晕厥或持续性VT或VF病史的患者相似。这些发现表明，ICD不仅在继发性预防，而且在IDC猝死的一级预防中可能都发挥作用。
