Verma Atul, Sarak Bradley, Kaplan Alexander J, Oosthuizen Richard, Beardsall Marianne, Wulffhart Zaev, Higenbottam Janet, Khaykin Yaariv
Southlake Regional Health Center, Newmarket, Ontario, Canada.
Pacing Clin Electrophysiol. 2010 Mar;33(3):320-9. doi: 10.1111/j.1540-8159.2009.02566.x. Epub 2009 Oct 1.
We sought to assess predictors of appropriate implantable cardioverter defibrillator (ICD) therapy in patients receiving primary prevention ICDs.
Four hundred twenty-one consecutive patients (ischemic and nonischemic) undergoing primary prevention ICD implantation were studied. Patients were grouped based on the presence/absence of appropriate ICD therapy. Summary data and stored electrograms from ICDs were reviewed to determine appropriateness of therapy. Predictors of therapy were assessed by both univariate and multivariate Cox regression analysis.
Of 421 primary prevention patients undergoing ICD implantation, 79 (19%) had received appropriate ICD therapies. By univariate comparison, nonsustained ventricular tachycardia (NSVT), male sex, left ventricle diastolic diameter (LVDD), and hypertension were all significant predictors for ICD therapy over a mean follow-up time of 751 +/- 493 days (P <or= 0.05). The use of beta-blockers was found to be a negative predictor. In the ischemic cardiomyopathy (ICM) population, 55 (17%) patients received ICD therapy and this was predicted by NSVT, hypertension, LVDD, and left atrial diameter.beta-blockers were protective. In the nonischemic dilated cardiomyopathy (NIDCM) population, 24 (23%) received appropriate therapies, which were predicted by NSVT, male sex, dual chamber device, lack of biventricular device, and lack of beta-blockers. By multivariate analysis, NSVT, hypertension, and lack of beta-blockers were significant for ICM, while NSVT and absence of beta-blockers were predictive for NIDCM. Ejection fraction, New York Heart Association class, and QRS width were not significantly different between therapy and no-therapy groups in any population.
ICD-delivered therapy occurred in 19% of primary prevention patients with both ischemic and dilated cardiomyopathy and was predicted by NSVT and a lack of beta-blocker use.
我们试图评估接受一级预防植入式心脏复律除颤器（ICD）治疗的患者中适当ICD治疗的预测因素。
对421例连续接受一级预防ICD植入的患者（包括缺血性和非缺血性患者）进行研究。根据是否接受适当的ICD治疗对患者进行分组。回顾ICD的汇总数据和存储的心电图以确定治疗的适当性。通过单因素和多因素Cox回归分析评估治疗的预测因素。
在421例接受ICD植入的一级预防患者中，79例（19%）接受了适当的ICD治疗。通过单因素比较，非持续性室性心动过速（NSVT）、男性、左心室舒张直径（LVDD）和高血压在平均751±493天的随访时间内均为ICD治疗的显著预测因素（P≤0.05）。发现使用β受体阻滞剂是一个负性预测因素。在缺血性心肌病（ICM）人群中，55例（17%）患者接受了ICD治疗，其预测因素为NSVT、高血压、LVDD和左心房直径。β受体阻滞剂具有保护作用。在非缺血性扩张型心肌病（NIDCM）人群中，24例（23%）接受了适当的治疗，其预测因素为NSVT、男性、双腔装置、无双心室装置和无β受体阻滞剂。通过多因素分析，NSVT、高血压和无β受体阻滞剂对ICM有显著意义，而NSVT和无β受体阻滞剂对NIDCM有预测作用。在任何人群中，治疗组和未治疗组之间的射血分数、纽约心脏协会分级和QRS宽度均无显著差异。
在19%的患有缺血性和扩张型心肌病的一级预防患者中发生了ICD治疗，其预测因素为NSVT和未使用β受体阻滞剂。
