Tsai Chia-Ti, Huang Shoei K Stephen, Lin Jiunn-Lee, Lai Ling-Ping
Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Pacing Clin Electrophysiol. 2003 Nov;26(11):2083-90. doi: 10.1046/j.1460-9592.2003.00324.x.
Little information about the ICD is available from the Asian Pacific region. The purpose of this study was to characterize the clinical features in ICD patients in Taiwan and to compare these features with those in patients in the Western populations, mainly the Canadian Implantable Defibrillator Study (CIDS), the Antiarrhythmics versus Implantable Defibrillator (AVID) trial, and the Cardiac Arrest Study Hamburg (CASH) trial. From February 1995 to October 2001, 101 ICDs were implanted in 92 patients (78 [84%] men) in 12 hospitals. Clinical presentations included sudden cardiac death due to VF/VT in 35 (38%) patients, syncopal VT in 25 (27%), drug refractory nonsyncopal VT in 27 (29%), and unexplained syncope with inducible sustained VT/VF in 5 (6%). The mean age was significantly younger than that in CIDS or AVID (59 +/- 16 vs 63 +/- 9 years in CIDS, P = 0.02; vs 65 +/- 11 years in AVID, P < 0.001), but was comparable to that in CASH (59 +/- 16 vs 58 +/- 11 years in CASH, P = 0.75). The mean LVEF was significantly higher than that in CIDS or AVID (48 +/- 19% vs 34 +/- 15% in CIDS, P < 0.001; vs 32 +/- 13% in AVID, P < 0.001), but was comparable to that in CASH (48 +/- 19 vs 46 +/- 19% in CIDS, P = 0.83). The ICD patients in the current study also showed a higher incidence of normal heart (23 vs 4% in CIDS, P < 0.001; vs 3% in AVID, P < 0.001; vs 9% in CASH, P < 0.001) and cardiomyopathy (41% vs 10% in CIDS, P < 0.001; vs 15% in AVID, P < 0.001; vs 11% in CASH, P < 0.001), but a lower incidence of coronary artery disease (29% vs 83% in CIDS, P < 0.001; vs 82% in AVID, P < 0.001; vs 73% in CASH, P < 0.001). During a mean follow-up of 28 +/- 24 months, 13 (14%) patients died. Older age was the only factor associated with poorer survival after ICD implantation. Forty-seven (51%) patients received appropriate ICD discharges during follow-up. History of prior myocardial infarction was the only factor associated with an earlier first appropriate ICD discharge and LVEF < 0.35 the only factor associated with subsequent poorer survival after the first ICD discharge. In conclusion, this study demonstrated many distinct clinical features in our ICD population that were different from those in the Western populations.
亚太地区关于植入式心律转复除颤器（ICD）的信息较少。本研究的目的是描述台湾ICD患者的临床特征，并将这些特征与西方人群中的患者进行比较，主要是加拿大植入式除颤器研究（CIDS）、抗心律失常药物与植入式除颤器（AVID）试验以及汉堡心脏骤停研究（CASH）试验。1995年2月至2001年10月，12家医院为92例患者（78例[84%]为男性）植入了101台ICD。临床表现包括35例（38%）患者因室颤/室速导致的心源性猝死、25例（27%）患者的晕厥性室速、27例（29%）患者的药物难治性非晕厥性室速以及5例（6%）患者伴有可诱发的持续性室速/室颤的不明原因晕厥。平均年龄显著低于CIDS或AVID中的患者（CIDS中为59±16岁，AVID中为65±11岁，本研究中为59±16岁，CIDS组与本研究组比较P = 0.02，AVID组与本研究组比较P < 0.001），但与CASH中的患者相当（CASH中为58±11岁，本研究中为59±16岁，P = 0.75）。平均左室射血分数（LVEF）显著高于CIDS或AVID中的患者（CIDS中为34±15%，AVID中为32±13%，本研究中为48±19%，CIDS组与本研究组比较P < 0.001，AVID组与本研究组比较P < 0.001），但与CASH中的患者相当（CASH中为46±19%，本研究中为48±19%，P = 0.83）。本研究中的ICD患者还显示出正常心脏的发生率较高（CIDS中为4%，AVID中为3%，CASH中为9%，本研究中为23%，CIDS组与本研究组比较P < 0.001，AVID组与本研究组比较P < 0.001，CASH组与本研究组比较P < 0.001）以及心肌病的发生率较高（CIDS中为10%，AVID中为15%，CASH中为11%，本研究中为41%，CIDS组与本研究组比较P < 0.001，AVID组与本研究组比较P < 0.001，CASH组与本研究组比较P < 0.001），但冠状动脉疾病的发生率较低（CIDS中为83%，AVID中为82%，CASH中为73%，本研究中为29%，CIDS组与本研究组比较P < 0.001，AVID组与本研究组比较P < 0.001，CASH组与本研究组比较P < 0.001）。在平均28±24个月的随访期间，13例（14%）患者死亡。年龄较大是ICD植入后生存率较差的唯一相关因素。47例（51%）患者在随访期间接受了ICD的恰当电击治疗。既往心肌梗死病史是首次恰当ICD电击治疗较早的唯一相关因素，而LVEF < 0.35是首次ICD电击治疗后随后生存率较差的唯一相关因素。总之，本研究证明了我们的ICD人群中存在许多与西方人群不同的独特临床特征。
