Yang Felix, Shah Bindi, Iwai Sei, Markowitz Steven M, Lerman Bruce B, Stein Kenneth M
Department of Cardiology, Beth Israel Medical Center, University Hospital of the Albert Einstein College of Medicine, New York, New York.
Pacing Clin Electrophysiol. 2008 Nov;31(11):1419-24. doi: 10.1111/j.1540-8159.2008.01205.x.
Although prophylactic implantable cardioverter-defibrillator (ICD) implantation is beneficial in patients with severe ischemic cardiomyopathy, it is unclear whether patients with cardiomyopathy due to valvular heart disease have a similar benefit.
We followed 17 patients (14 men/three women, age 62 +/- 13 years, left ventricular ejection fraction [LVEF] 29 +/- 10%) who had nonischemic valvular cardiomyopathy, underwent valvular heart surgery (aortic valve replacement, mitral valve replacement, and/or mitral valve repair), and subsequently had an electrophysiology study (EPS), for a median of 2.8 years. These patients were compared with 34 patients with prior myocardial infarction and no significant valvular heart disease, who were matched (1:2) for age, gender, LVEF, EPS result, T-wave alternans result, and ICD placement. Occurrence of arrhythmias was ascertained from ICD device clinic follow-up and vital status was determined using the National Death Index.
There were no differences between the groups in overall survival (P = 0.24) or arrhythmia-free survival (P = 0.38), and the 2-year arrhythmia-free survival was 82% for the valvular patients versus 73% for the ischemic patients. Among patients with ICDs, there was no difference between the groups in overall survival (P = 0.34), time to first appropriate ICD therapy (P = 0.54), and arrhythmia-free survival (P = 0.51).
Patients with valvular cardiomyopathy and residual left ventricular dysfunction following valvular surgery who underwent a tailored approach to ICD implantation had similar overall and arrhythmia-free survival as patients with ischemic cardiomyopathy.
尽管预防性植入心脏复律除颤器（ICD）对严重缺血性心肌病患者有益，但对于瓣膜性心脏病所致心肌病患者是否有类似益处尚不清楚。
我们随访了17例患者（14例男性/3例女性，年龄62±13岁，左心室射血分数[LVEF]29±10%），这些患者患有非缺血性瓣膜性心肌病，接受了心脏瓣膜手术（主动脉瓣置换、二尖瓣置换和/或二尖瓣修复），随后进行了电生理研究（EPS），随访时间中位数为2.8年。将这些患者与34例既往有心肌梗死且无明显瓣膜性心脏病的患者进行比较，后者在年龄、性别、LVEF、EPS结果、T波交替结果和ICD植入方面进行了匹配（1:2）。心律失常的发生通过ICD设备门诊随访确定，生命状态使用国家死亡指数确定。
两组在总生存率（P = 0.24）或无心律失常生存率（P = 0.38）方面无差异，瓣膜性心脏病患者的2年无心律失常生存率为82%，缺血性心脏病患者为73%。在植入ICD的患者中，两组在总生存率（P = 0.34）、首次适当ICD治疗时间（P = 0.54）和无心律失常生存率（P = 0.51）方面无差异。
瓣膜性心肌病且瓣膜手术后左心室功能仍有残余障碍的患者，采用个体化ICD植入方法，其总生存率和无心律失常生存率与缺血性心肌病患者相似。
