Costa Roberto, Silva Kátia Regina da, Mendonça Rodrigo Castro, Nishioka Silvana Angelina D'Orio, Siqueira Sérgio de Freitas, Tamaki Wagner Tetsuji, Crevelari Elizabeth Sartori, Moreira Luiz Felipe Pinho, Filho Martino Martinelli
Instituto do Coração, Hospital das Clínicas de São Paulo, FM, USP, São Paulo, SP, Brazil.
Arq Bras Cardiol. 2007 Mar;88(3):258-64. doi: 10.1590/s0066-782x2007000300002.
To analyze the incidence and causes of ICD therapies in children and young adults and verify their impact on the quality of life (QoL).
From March/1977 to February/2006, 29 patients (15.7+/-5.4 years old) were submitted to ICD implants. Aborted cardiac arrest (41.5%), sustained ventricular tachycardia (27.6%) and primary prophylaxis of sudden cardiac death (30.9%) indicated device therapy. The number of therapies was evaluated by interviewing patients and by ICD diagnostic data. The SF-36 questionnaire was used to measure the QoL and the results were compared to healthy population. The expectative of freedom from ICD therapies were estimated by the Kaplan-Meier method.
After 2.6+/-1.8 years follow-up, 8 (27.6%) patients received 141 appropriate ICD shocks due to ventricular tachycardia (6) or ventricular fibrillation (2), and 11 (37.9%) patients received 152 inappropriate ICD shocks due to supraventricular tachyarrhythmias (8) or oversensing (3). Expectative of freedom from appropriate shocks was 74.2+/-9.0% and 66.7+/-10.7% after one and three years, respectively. Compared to healthy population, QoL decreased in physical function (61.7+/-28.7), vitality (64.7+/-19.1), mental health (65.9+/-22.7) and role-emotional domains (66.7+/-38.5). All patients referred fear and concern related to ICD use.
Despite the efficacy of ICD therapies, the high incidence of appropriate and inappropriate shocks interfered in patients QoL and adaptation to the device.
分析儿童和青年成人接受植入式心律转复除颤器（ICD）治疗的发生率及原因，并验证其对生活质量（QoL）的影响。
从1977年3月至2006年2月，29例患者（年龄15.7±5.4岁）接受了ICD植入。心脏骤停未遂（41.5%）、持续性室性心动过速（27.6%）和心脏性猝死的一级预防（30.9%）表明需要进行器械治疗。通过访谈患者和ICD诊断数据来评估治疗次数。使用SF-36问卷测量生活质量，并将结果与健康人群进行比较。采用Kaplan-Meier方法估计无ICD治疗的预期时间。
经过2.6±1.8年的随访，8例（27.6%）患者因室性心动过速（6例）或心室颤动（2例）接受了141次适当的ICD电击，11例（37.9%）患者因室上性快速心律失常（8例）或感知过度（3例）接受了152次不适当的ICD电击。1年和3年后无适当电击的预期时间分别为74.2±9.0%和66.7±10.7%。与健康人群相比，身体功能（61.7±28.7）、活力（64.7±19.1）、心理健康（65.9±22.7）和角色情感领域（66.7±38.5）的生活质量有所下降。所有患者均表示对使用ICD存在恐惧和担忧。
尽管ICD治疗有效，但适当和不适当电击的高发生率干扰了患者的生活质量和对该器械的适应。
