Woo Anna, Monakier Daniel, Harris Louise, Hill Ann, Shah Prasad, Wigle E Douglas, Rakowski Harry, Rozenblyum Evelyn, Cameron Douglas A
Division of Cardiology, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada.
Heart. 2007 Sep;93(9):1044-5. doi: 10.1136/hrt.2006.090290.
To identify the determinants of appropriate and inappropriate implantable cardioverter-defibrillator (ICD) discharges in patients with hypertrophic cardiomyopathy (HCM).
Retrospective cohort study.
ICD clinic at an academic hospital.
61 patients with HCM who received ICDs for the primary or secondary prevention of sudden cardiac death (SCD).
(a) Analysis of appropriate and inappropriate ICD discharges; (b) predictors of ICD discharges.
Mean (SD) age at ICD insertion was 46 (18) years (range 10-79). Follow-up time was 40 (27) months (range 7-151). Eight patients experienced an appropriate discharge, occurring 24.5 (13.6) months after ICD insertion. Appropriate ICD intervention was more common in the secondary (36%) than the primary (8%) prevention group (p = 0.02). Inappropriate ICD discharges occurred in 20 (33%) patients. Multivariate Cox regression analysis identified two significant predictors of inappropriate ICD discharges: (a) age <30 years at the time of ICD insertion (hazard ratio (HR) = 3.0 (95% CI 1.1 to 8.0; p = 0.03) and (b) history of atrial fibrillation (HR = 3.1 (95% CI 1.2 to 8.1; p = 0.02).
ICDs are effective in the prevention of SCD in HCM. However, there is a high incidence of inappropriate ICD discharges.
确定肥厚型心肌病（HCM）患者中合适及不合适的植入式心律转复除颤器（ICD）放电的决定因素。
回顾性队列研究。
一所学术医院的ICD诊所。
61例因心脏性猝死（SCD）的一级或二级预防而接受ICD植入的HCM患者。
（a）合适及不合适的ICD放电分析；（b）ICD放电的预测因素。
ICD植入时的平均（标准差）年龄为46（18）岁（范围10 - 79岁）。随访时间为40（27）个月（范围7 - 151个月）。8例患者经历了合适的放电，发生在ICD植入后24.5（13.6）个月。合适的ICD干预在二级预防组（36%）比一级预防组（8%）更常见（p = 0.02）。20例（33%）患者发生了不合适的ICD放电。多因素Cox回归分析确定了不合适ICD放电的两个显著预测因素：（a）ICD植入时年龄<30岁（风险比（HR）= 3.0（95%可信区间1.1至8.0；p = 0.03））和（b）心房颤动病史（HR = 3.1（95%可信区间1.2至8.1；p = 0.02））。
ICD对预防HCM患者的SCD有效。然而，不合适的ICD放电发生率很高。
