Boriani Giuseppe, Artale Paolo, Biffi Mauro, Martignani Cristian, Frabetti Lorenzo, Valzania Cinzia, Diemberger Igor, Ziacchi Matteo, Bertini Matteo, Rapezzi Claudio, Parlapiano Mario, Branzi Angelo
Istituto di Cardiologia, Università di Bologna, Policlinico S. Orsola-Malpighi, via Massarenti 9, 40138, Bologna, Italy.
Heart Vessels. 2007 May;22(3):184-92. doi: 10.1007/s00380-006-0963-8. Epub 2007 May 21.
The aim of the present study was to investigate outcomes of implantable cardioverter-defibrillator (ICD) treatment in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC). We reviewed baseline/follow-up data of 15 consecutive ARVC patients (mean age 55 +/- 15 years) and 30 randomly drawn patients with coronary artery disease (CAD) (mean age 60 +/- 10 years) with matching durations of follow-up (all implanted with ICDs for primary/secondary prevention of sudden death). At implant, appropriate placement of the RV lead was more difficult in ARVC patients. During follow-up (median 41 months), appropriate interventions for any ventricular tachyarrhythmias occurred in 8 (53%) ARVC patients and 17 (57%) CAD patients, but the occurrence of high rate (>240 beats/min) ventricular tachyarrhythmias was higher in ARVC patients. Inappropriate ICD interventions occurred in 5 (33%) ARVC patients and 10 (33%) CAD patients. Lead-related adverse events requiring surgical revision occurred in 7 (47%) ARVC patients as compared with 4 (13%) CAD patients (P = 0.0004). While ICD implantation is highly effective for prevention of sudden death in ARVC, it does carry elevated burdens of long-term lead-related adverse events. These findings underline the need of careful follow-up in ARVC aimed at early recognition of complications that can impair ICD function.
本研究的目的是调查植入式心律转复除颤器（ICD）治疗致心律失常性右室心肌病（ARVC）患者的疗效。我们回顾了15例连续的ARVC患者（平均年龄55±15岁）和30例随机抽取的冠心病（CAD）患者（平均年龄60±10岁）的基线/随访数据，两组随访时间匹配（均植入ICD用于一级/二级预防猝死）。在植入时，ARVC患者右室导线正确放置更困难。随访期间（中位时间为月41），8例（53%）ARVC患者和17例（57%）CAD患者发生了针对任何室性快速心律失常的适当干预，但ARVC患者发生高心率（>240次/分钟）室性快速心律失常的比例更高。5例（33%）ARVC患者和10例（33%）CAD患者发生了不适当的ICD干预。与4例（13%）CAD患者相比，7例（47%）ARVC患者发生了需要手术翻修的导线相关不良事件（P=0.0004）。虽然ICD植入对预防ARVC患者猝死非常有效，但确实会带来与导线相关的长期不良事件负担增加。这些发现强调了对ARVC患者进行仔细随访的必要性，旨在早期识别可能损害ICD功能的并发症。
