Department of Cardiology, Copenhagen University Hospital Gentofte, Niels Andersens Vej 65, Internal Post 4210, 2900 Hellerup, Denmark.
Europace. 2010 Feb;12(2):254-60. doi: 10.1093/europace/eup383. Epub 2009 Dec 16.
The aims of this study were to describe arrhythmias documented with an implantable loop recorder (ILR) in post-acute myocardial infarction (AMI) patients with left ventricular dysfunction at the time of death and to establish the correlation to mode of death.
Post-mortem ILR device interrogations were analysed from patients dying in the CARISMA study. Mode of death was classified by a modified CAST classification. Twenty-six patients died with an implanted ILR. Of these, 16 had an electrocardiogram recorded at the time of death. Ventricular tachycardia (VT)/ventricular fibrillation (VF) was terminal rhythm in eight patients and bradyarrhythmias were observed in another eight patients. Of the deaths with peri-mortem recordings, seven were classified as sudden cardiac death (SCD). In six of these, VF was documented at the time of death. Six monitored deaths were classified as non-SCD (NSCD) of which only two had recordings of VT/VF, whereas four had bradyarrhythmias. All peri-mortem recordings in non-cardiac death (NCD) were bradyarrhythmia.
Long-term monitoring in a population of post-AMI patients with left ventricular ejection fraction < or =40% showed that VT/VF and bradyarrhythmia each accounted for half of the recorded events at the time of death. The ILR confirmed that ventricular tachyarrhythmias are associated primarily with SCD, whereas bradyarrhythmias and electromechanical dissociation seems dominant in NSCD and NCD. The study was registered at ClinicalTrials.gov: NCT00145119.
本研究旨在描述左心室功能障碍的急性心肌梗死后（AMI）患者死亡时记录的心律失常，并确定与死亡方式的相关性。
对 CARISMA 研究中死亡患者的植入式环路记录器（ILR）进行了死后 ILR 设备检测分析。通过改良 CAST 分类对死亡方式进行分类。26 例患者死亡时植入 ILR。其中 16 例在死亡时记录了心电图。8 例患者出现室性心动过速（VT）/心室颤动（VF）作为终末节律，另 8 例患者出现缓慢性心律失常。在有围死亡期记录的死亡中，7 例被归类为心源性猝死（SCD）。在这 6 例患者中，VF 在死亡时被记录。6 例监测死亡被归类为非 SCD（NSCD），其中只有 2 例有 VT/VF 记录，而 4 例有缓慢性心律失常。非心源性死亡（NCD）的所有围死亡期记录均为缓慢性心律失常。
在左心室射血分数<或=40%的 AMI 后患者人群中进行的长期监测显示，VT/VF 和缓慢性心律失常在死亡时记录的事件中各占一半。ILR 证实，室性心动过速与 SCD 主要相关，而缓慢性心律失常和电机械分离似乎在 NSCD 和 NCD 中占主导地位。该研究在 ClinicalTrials.gov 上注册：NCT00145119。
