冠状动脉旁路移植术后收缩功能障碍患者植入式心脏复律除颤器的使用不足

Underutilization of implantable cardioverter defibrillators post coronary artery bypass grafting in patients with systolic dysfunction.

作者信息

John Jerry M, Hussein Ahmed, Imran Naser, Durham Samuel J, Grubb Blair P, Kanjwal Yousuf

机构信息

University of Toledo Medical Center, Toledo, Ohio, USA.

出版信息

Pacing Clin Electrophysiol. 2010 Jun 1;33(6):727-33. doi: 10.1111/j.1540-8159.2010.02700.x. Epub 2010 Feb 18.

DOI:10.1111/j.1540-8159.2010.02700.x

PMID:20180917

Abstract

BACKGROUND

Evaluation of the need for prophylactic internal cardiac defibrillators among patients with ischemic cardiomyopathies should be deferred until at least 3 months after revascularization procedures to allow adequate time for recovery of ventricular function.

METHODS

Among patients with left ventricular systolic dysfunction (LVSD) who undergo coronary artery bypass grafting (CABG), the proportion of patients who are risk stratified postoperatively with reassessment of left ventricular ejection fraction (LVEF) is unknown.

RESULTS

One hundred and six patients with LVSD (LVEF < 40%) who underwent CABG during 2004-2006 and survived 3 months post CABG were evaluated. Follow-up was assessed by chart review and telephone contact. LVEF was not reassessed in 24% (25/106) of the population, none of whom underwent internal cardioverter defibrillator (ICD) implantation. Of those with LVEF reassessed, persistent LVSD was present in 20/81 (25%), 12 of whom were referred for prophylactic ICD placement.

CONCLUSION

One-fourth of patients with LVSD who undergo CABG do not have LVEF reassessed postoperatively which may lead to underutilization of ICDs.

摘要

背景

对于缺血性心肌病患者，预防性植入心脏除颤器的必要性评估应推迟至血运重建术后至少3个月，以便有足够时间让心室功能恢复。

方法

在接受冠状动脉旁路移植术（CABG）的左心室收缩功能障碍（LVSD）患者中，术后通过重新评估左心室射血分数（LVEF）进行风险分层的患者比例尚不清楚。

结果

对2004年至2006年期间接受CABG且术后存活3个月的106例LVSD患者（LVEF<40%）进行了评估。通过查阅病历和电话联系进行随访。24%（25/106）的患者未重新评估LVEF，这些患者均未植入体内除颤器（ICD）。在重新评估LVEF的患者中，20/81（25%）存在持续性LVSD，其中12例被转诊接受预防性ICD植入。