Begley David A, Mohiddin Saidi A, Tripodi Dorothy, Winkler Judith B, Fananapazir Lameh
Cardiovascular Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA.
Pacing Clin Electrophysiol. 2003 Sep;26(9):1887-96. doi: 10.1046/j.1460-9592.2003.00285.x.
Risk stratification and effectiveness of implantable cardioverter-defibrillator (ICD) therapy are unresolved issues in hypertrophic cardiomyopathy (HCM), a cardiac disease that is associated with arrhythmias and sudden death. We assessed ICD therapy in 132 patients with HCM: age at implantation was 34 +/- 17 years, and 44 (33%) patients were aged </= 20 years. Indications were sustained ventricular tachycardia (VT) or cardiac arrest (secondary prevention) in 47 (36%) patients, and clinical features associated with increased risk for sudden death (primary prevention) in 85 (64%) patients. There were 6 deaths and 55 appropriate interventions in 27 (20%) patients during a mean follow-up period of 4.8 +/- 4.2 years: 5-year survival and event-free rates were 96%+/- 2%and 75%+/- 5%, respectively. ICD intervention-free rates were significantly less for secondary than for primary prevention:64%+/- 7%versus 84%+/- 6%at 5 years,P = 0.02. Notably, 59 of 67 events (cardiac arrest and therapeutic ICD interventions), or 88%, occurred during sedentary or noncompetitive activity. Incidence of therapeutic shocks was related to age but not to other reported risk factors, including severity of cardiac hypertrophy, nonsustained VT during Holter monitoring, and abnormal blood pressure response to exercise. ICD related complications occurred in 38 (29%) patients, including 60 inappropriate ICD interventions in 30 (23%) patients. However, 8 (27%) of the patients with inappropriate shocks also had therapeutic interventions. ICD is effective for secondary prevention of sudden death in HCM. However, selection of patients for primary prevention of sudden death, and prevention of device related complications require further refinement.
在肥厚型心肌病（HCM）中，植入式心脏复律除颤器（ICD）治疗的风险分层和有效性仍是未解决的问题，HCM是一种与心律失常和猝死相关的心脏病。我们评估了132例HCM患者的ICD治疗情况：植入时年龄为34±17岁，44例（33%）患者年龄≤20岁。47例（36%）患者的植入指征为持续性室性心动过速（VT）或心脏骤停（二级预防），85例（64%）患者的植入指征为与猝死风险增加相关的临床特征（一级预防）。在平均4.8±4.2年的随访期内，27例（20%）患者中有6例死亡，55例进行了适当干预：5年生存率和无事件发生率分别为96%±2%和75%±5%。二级预防的ICD无干预率显著低于一级预防：5年时分别为64%±7%和84%±6%，P = 0.02。值得注意的是，67例事件（心脏骤停和治疗性ICD干预）中的59例（88%）发生在久坐或非竞技活动期间。治疗性电击的发生率与年龄有关，但与其他报告的风险因素无关，包括心脏肥厚的严重程度、动态心电图监测期间的非持续性VT以及运动时的异常血压反应。38例（29%）患者发生了ICD相关并发症，包括30例（23%）患者出现60次不适当的ICD干预。然而，8例（27%）接受不适当电击的患者也进行了治疗性干预。ICD对HCM猝死的二级预防有效。然而，对于猝死一级预防患者的选择以及设备相关并发症的预防需要进一步完善。
