Edel T B, Maloney J D, Moore S L, McAllister H, Gohn D, Shewchik J M, Alexander L, Firstenberg M S, Castle L W, Simmons T W
Cleveland Clinic Foundation, Ohio 44195-5064.
Pacing Clin Electrophysiol. 1992 Jan;15(1):60-70. doi: 10.1111/j.1540-8159.1992.tb02902.x.
The cause of death and clinical characteristics of 26 patients that died after implantable cardioverter defibrillator placement were reviewed and compared to the 145 patients still living after a mean follow-up of 17 months. Operative mortality was 4% (7/171) and resulted from postoperative ventricular arrhythmias (four patients), heart failure (two patients), and respiratory failure (one patient). Operative mortality was significantly higher (1.7% vs 9.6%, P less than 0.05) following concomitant surgical procedures. Total late mortality was 11% (18/171). Thirteen deaths (75%) occurred in-hospital from progressive deterioration of left ventricular function (nine patients), arrhythmia (two patients), and noncardiac causes (two patients). Outpatient mortality was 3.5% (6/171) and resulted from presumed sudden cardiac death in five of six patients; two of the five had devices that were inactive, one had high defibrillation thresholds, and two had suspected bradyarrhythmic deaths. One postoperative death and one late in-hospital death were also considered sudden cardiac deaths for a total of seven patients with defibrillation system failures. By multivariant analysis, preoperative clinical characteristics associated with a worse prognosis following defibrillator implantation were identified: presentation as ventricular tachycardia (P less than 0.02), induction of sustained monomorphic ventricular tachycardia (P less than 0.05), poor left ventricular performance (P less than 0.01), poor functional status (P less than 0.001), and the use of diuretics (P less than 0.01). Frequent device discharges (P less than 0.001) and concomitant antitachycardia pacing systems (P less than 0.001) were markers for greater arrhythmia recurrence and were potent predictors of a worse prognosis and particularly sudden death.
回顾了26例植入式心脏复律除颤器置入术后死亡患者的死因及临床特征，并与平均随访17个月后仍存活的145例患者进行了比较。手术死亡率为4%（7/171），死因包括术后室性心律失常（4例）、心力衰竭（2例）和呼吸衰竭（1例）。同期进行外科手术时，手术死亡率显著更高（1.7%对9.6%，P<0.05）。晚期总死亡率为11%（18/171）。13例死亡（75%）发生在医院内，原因是左心室功能进行性恶化（9例）、心律失常（2例）和非心脏原因（2例）。门诊死亡率为3.5%（6/171），6例中有5例被认为是心源性猝死；5例中有2例装置未激活，1例除颤阈值高，2例疑似缓慢性心律失常死亡。1例术后死亡和1例晚期院内死亡也被认为是心源性猝死，共有7例患者出现除颤系统故障。通过多变量分析，确定了与植入除颤器后预后较差相关的术前临床特征：表现为室性心动过速（P<0.02）、诱发持续性单形性室性心动过速（P<0.05）、左心室功能差（P<0.01）、功能状态差（P<0.001）以及使用利尿剂（P<0.01）。频繁的装置放电（P<0.001）和同期抗心动过速起搏系统（P<0.001）是心律失常复发增加的标志，也是预后较差尤其是猝死的有力预测指标。
