Otmani Akli, Trinquart Ludovic, Marijon Eloi, Lavergne Thomas, Waintraub Xavier, Lepillier Antoine, Chatellier Gilles, Le Heuzey Jean-Yves
Université Paris-Descartes, Hôpital Européen Georges Pompidou, AP-HP, Service de Cardiologie A, 20 rue Leblanc, 75908 Paris Cedex 15, France.
Am Heart J. 2009 Aug;158(2):230-237.e1. doi: 10.1016/j.ahj.2009.05.019.
The implantable cardioverter defibrillator (ICD) is the therapy of choice in patients at risk for sudden cardiac death in both primary and secondary prevention indication. There are no recent data concerning the delivery rate and etiology of appropriate ICD therapies in routine medical care.
The EVADEF study was a French multicenter, prospective, observational cohort study of ICD patients with a 2-year follow-up. Every 6 months we recorded patients' survival status and evaluated appropriate ICD therapies-antitachycardia pacing or shocks. Causes of ICD activation were also recorded from among ventricular tachycardia (VT), fast VT and ventricular fibrillation (VF).
From 2001 to 2003, 2296 unselected patients were implanted and followed until 2005. During a mean follow-up of 20.5 months, 274 deaths occurred. In 2009 patients with cardiopathy, 22 patients per 100 person-years had at least one appropriate therapy. Twenty-four and 11 patients per 100 person-years had at least one therapy in secondary and primary prevention, respectively. Age >65 years, left ventricular ejection fraction <30% and secondary prevention were independently associated with appropriate therapy. Besides, 5 patients per 100 person-years had at least 1 episode of life-threatening arrhythmia (fast VT or VF). Left ventricular ejection fraction <30% and secondary prevention were independently associated with life-threatening arrhythmia. In 287 patients without cardiopathy, the rate of appropriate therapy was twice as less, whereas the rate of life-threatening arrhythmia was similar.
Over a 24-month follow-up, the rate of appropriate therapy was substantial while few patients had life-threatening arrhythmia. Appropriate therapies and life-threatening arrhythmia were more frequent in patients with secondary prevention indication.
在一级和二级预防指征中，植入式心脏复律除颤器（ICD）是心脏性猝死高危患者的首选治疗方法。目前尚无关于常规医疗中ICD恰当治疗的发生率及病因的最新数据。
EVADEF研究是一项在法国进行的多中心、前瞻性、观察性队列研究，对ICD患者进行了为期2年的随访。每6个月记录患者的生存状态，并评估恰当的ICD治疗——抗心动过速起搏或电击。ICD激活的原因也记录在室性心动过速（VT）、快速VT和心室颤动（VF）之中。
从2001年到2003年，2296例未经选择的患者接受了植入并随访至2005年。在平均20.5个月的随访期间，发生了274例死亡。在2009例患有心脏病的患者中，每100人年有22例患者至少接受过一次恰当治疗。在二级预防和一级预防中，每100人年分别有24例和11例患者至少接受过一次治疗。年龄>65岁、左心室射血分数<30%以及二级预防与恰当治疗独立相关。此外,每100人年有5例患者至少发生1次危及生命的心律失常（快速VT或VF）。左心室射血分数<30%和二级预防与危及生命的心律失常独立相关。在287例无心脏病的患者中，恰当治疗的发生率低两倍，而危及生命的心律失常发生率相似。
在24个月的随访中，恰当治疗的发生率较高，而很少有患者发生危及生命的心律失常。二级预防指征的患者中，恰当治疗和危及生命的心律失常更为常见。
