Lunati Maurizio, Gasparini Maurizio, Bocchiardo Mario, Curnis Antonio, Landolina Maurizio, Carboni Angelo, Luzzi Gianni, Zanotto Gabriele, Ravazzi Pierantonio, Magenta Giovanni, Denaro Alessandra, Distefano Paola, Grammatico Andrea
Cardiology, Niguarda Ca' Granda Hospital Milano, Milano, Italy.
J Cardiovasc Electrophysiol. 2006 Dec;17(12):1299-306. doi: 10.1111/j.1540-8167.2006.00618.x.
Temporal patterns of ventricular tachyarrhythmia (VT/VF) have been studied only in patients who have received implantable cardioverter defibrillators (ICD) for secondary prevention of sudden death, and mainly in ischemic patients. The aim of this study was to evaluate VT/VF recurrence patterns in heart failure (HF) patients with biventricular ICD and to stratify results according to HF etiology and ICD indication.
We studied 421 patients (91% male, 66 +/- 9 years). HF etiology was ischemic in 292 patients and nonischemic in 129. ICD indication was for primary prevention in 227 patients and secondary prevention in 194. Baseline left ventricular ejection fraction (LVEF) was 26 +/- 7%, QRS duration 168 +/- 32 msec, and NYHA class 2.9 +/- 0.6. In a follow-up of 19 +/- 11 months, 1,838 VT/VF in 110 patients were appropriately detected. In 59 patients who had > or = 4 episodes, we tried to determine whether VT/VF occurred randomly or rather tended to cluster by fitting the frequency distribution of tachycardia interdetection intervals with exponential functions: VT/VF clusters were observed in 46 patients (78% of the subgroup of patients with > or = 4 episodes and 11% of the overall population). On multivariate logistic analysis, VT/VF clusters were significantly (P < 0.01) associated with ICD indication for secondary prevention (odds ratio [OR] = 3.12; confidence interval [CI] = 1.56-6.92), nonischemic HF etiology (OR = 4.34; CI = 2.02-9.32), monomorphic VT (OR = 4.96; CI = 2.28-10.8), and LVEF < 25% (OR = 3.34; CI = 1.54-7.23). Cardiovascular hospitalizations and deaths occurred more frequently in cluster (21/46 [46%]) than in noncluster patients (63/375 (17%), P < 0.0001).
In HF patients with biventricular ICDs, VT/VF clusters may be regarded as the epiphenomenon of HF deterioration or as a marker of suboptimal response to cardiac resynchronization therapy.
室性快速心律失常（VT/VF）的时间模式仅在接受植入式心脏复律除颤器（ICD）用于猝死二级预防的患者中进行过研究，且主要是在缺血性患者中。本研究的目的是评估双心室ICD治疗的心力衰竭（HF）患者中VT/VF的复发模式，并根据HF病因和ICD适应证对结果进行分层。
我们研究了421例患者（男性占91%，年龄66±9岁）。292例患者的HF病因是缺血性的，129例是非缺血性的。227例患者的ICD适应证为一级预防，194例为二级预防。基线左心室射血分数（LVEF）为26±7%，QRS时限为168±32毫秒，纽约心脏协会（NYHA）心功能分级为2.9±0.6。在19±11个月的随访中，110例患者发生了1838次VT/VF并被适当检测到。在59例发作次数≥4次的患者中，我们试图通过将心动过速相互检测间隔的频率分布与指数函数拟合来确定VT/VF是随机发生还是倾向于聚集：46例患者（发作次数≥4次的亚组中的78%，总体人群中的11%）观察到VT/VF聚集。多因素逻辑分析显示，VT/VF聚集与ICD二级预防适应证（优势比[OR]=3.12；置信区间[CI]=1.56 - 6.92）、非缺血性HF病因（OR = 4.34；CI = 2.02 - 9.32）、单形性VT（OR = 4.96；CI = 2.28 - 10.8）和LVEF<25%（OR = 3.34；CI = 1.54 - 7.23）显著相关（P<0.01）。心血管住院和死亡在聚集组（21/46 [46%]）中比非聚集组患者（63/375 [17%]）更频繁发生（P<0.0001）。
在双心室ICD治疗的HF患者中，VT/VF聚集可被视为HF恶化的附带现象或心脏再同步治疗反应欠佳的标志物。
