Cleveland Clinic, Sydell and Arnold Miller Family Heart and Vascular Institute, Cleveland, Ohio 44195, USA.
Heart Rhythm. 2010 Apr;7(4):466-71. doi: 10.1016/j.hrthm.2009.12.022. Epub 2010 Jan 4.
Ventricular tachyarrhythmia events (VTE) are common among refractory heart failure patients requiring ventricular assist device (VAD) support. It is unknown whether implantable cardioverter-defibrillator (ICD) detection and therapy can extend survival in the VAD population.
The purpose of this study was to evaluate the survival experience of refractory heart failure patients requiring VAD support with and without a concomitant ICD.
Multivariable analysis of the Cleveland Clinic registry of consecutive patients with and without an ICD who underwent VAD placement between 1991 and 2008 using traditional and propensity-matched methods. The primary endpoint was all-cause mortality.
Among 478 VAD recipients (age 53.5 +/- 12.0 years, 80% male), 90 patients (18.8%) had an ICD at the time of VAD placement. VTE occurred in 26 patients (28.9%) at a mean of 32.4 +/- 47.1 days, with appropriate treatment in 24 patients (75% initial shock, 25% successful antitachycardia pacing). A concomitant ICD during VAD support was associated with a significant reduction in mortality (hazard ratio [HR] 0.55 [confidence interval 0.32-0.94]; P = .028) after adjustment for age, gender, left ventricular ejection fraction, VAD type, year placed, diagnosis and duration, complications, dialysis-dependent renal failure, and extended survival (median survival 295 vs. 226 days; P = .024). A propensity-matched analysis of 134 patients with and without ICD also demonstrated that a concomitant ICD was associated with lower all-cause mortality (odds ratio 0.42 [confidence interval 0.19-0.95]; P = .04).
A concomitant ICD among VAD recipients is associated with extended survival.
在需要心室辅助装置（VAD）支持的难治性心力衰竭患者中，室性心动过速事件（VTE）很常见。目前尚不清楚植入式心脏复律除颤器（ICD）的检测和治疗是否可以延长 VAD 患者的生存率。
本研究旨在评估伴有和不伴有 ICD 的难治性心力衰竭患者在接受 VAD 支持后的生存情况。
使用传统和倾向匹配方法，对 1991 年至 2008 年期间连续接受 VAD 植入的伴有和不伴有 ICD 的克利夫兰诊所登记患者进行多变量分析。主要终点是全因死亡率。
在 478 名 VAD 接受者中（年龄 53.5 +/- 12.0 岁，80%为男性），90 名患者（18.8%）在 VAD 植入时配备了 ICD。26 例患者（28.9%）发生 VTE，平均时间为 32.4 +/- 47.1 天，24 例患者（75%初始电击，25%成功抗心动过速起搏）进行了适当治疗。在调整年龄、性别、左心室射血分数、VAD 类型、植入年份、诊断和持续时间、并发症、依赖透析的肾功能衰竭和延长生存时间后，VAD 支持期间同时使用 ICD 与死亡率显著降低相关（风险比 [HR] 0.55 [置信区间 0.32-0.94]；P =.028）。对 134 名伴有和不伴有 ICD 的患者进行倾向匹配分析也表明，同时使用 ICD 与全因死亡率降低相关（比值比 0.42 [置信区间 0.19-0.95]；P =.04）。
在 VAD 接受者中同时使用 ICD 与延长生存时间相关。
