Sasaki Sae, Niwano Shinichi, Fukaya Hidehira, Yuge Masaru, Imaki Ryuta, Inomata Takayuki, Izumi Tohru
Department of Cardio-angiology, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan.
Int Heart J. 2007 Mar;48(2):155-63. doi: 10.1536/ihj.48.155.
Ventricular tachyarrhythmia is one of the most important factors determining the prognosis of patients with heart failure and sudden death can be observed even during stable therapy controlling clinical heart failure. In this study, the usefulness of electrophysiologic study (EPS) for the prediction of a future arrhythmic event was evaluated in patients with heart failure.
The patient population consisted of 474 patients with a history of clinical heart failure but without an episode of spontaneous sustained ventricular tachycardia or fibrillation (VT/VF). A Holter ECG was performed in all patients, and 177 of the 474 patients underwent EPS because of a recording of nonsustained VT (NSVT, > 5 beats). When sustained VT/VF was inducible in EPS, the patient was assigned to implantation of a defibrillation device. The patients were divided into 3 groups, ie, 1) no NSVT (n = 297), 2) NSVT + no inducible VT/VF (n = 134), and 3) NSVT + inducible VT/VF (n = 43), and were followed-up for > 12 months. All patients were followed-up under standard therapy for heart failure. There were no significant differences in basic clinical characteristics and therapies among the 3 groups. During the follow-up period of 32 +/- 18 months, 56/474 patients suffered a VT/VF episode, ie, 21/297 in no NSVT, 14/134 in NSVT + no inducible VT/VF, and 21/43 in NSVT + inducible VT/VF patients (P = 0.032). All patients were rescued from sudden death among patients with an implanted defibrillator, but 11 patients without a defibrillator died.
In patients with heart failure, future arrhythmic events could be predicted by EPS and Holter ECG. EPS-guided risk stratification seems to be useful in managing patients with heart failure.
室性快速心律失常是决定心力衰竭患者预后的最重要因素之一，即使在控制临床心力衰竭的稳定治疗期间也可能发生猝死。在本研究中，对心力衰竭患者评估了电生理检查（EPS）预测未来心律失常事件的有效性。
患者群体包括474例有临床心力衰竭病史但无自发持续性室性心动过速或颤动（VT/VF）发作的患者。所有患者均进行了动态心电图检查，474例患者中有177例因记录到非持续性VT（NSVT，>5次搏动）而接受了EPS检查。当EPS可诱发持续性VT/VF时，患者被安排植入除颤装置。患者分为3组，即1）无NSVT（n = 297），2）NSVT + 不可诱发VT/VF（n = 134），3）NSVT + 可诱发VT/VF（n = 43），并随访>12个月。所有患者均在心力衰竭标准治疗下进行随访。3组之间的基本临床特征和治疗方法无显著差异。在32±18个月的随访期内，474例患者中有56例发生了VT/VF发作，即无NSVT组21/297例，NSVT + 不可诱发VT/VF组14/134例，NSVT + 可诱发VT/VF组21/43例（P = 0.032）。植入除颤器的患者均从猝死中获救，但11例未植入除颤器的患者死亡。
在心力衰竭患者中，EPS和动态心电图可预测未来心律失常事件。EPS指导的风险分层似乎有助于管理心力衰竭患者。
