Cardiac Arrhythmia Service, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA.
Heart Rhythm. 2010 Mar;7(3):353-60. doi: 10.1016/j.hrthm.2009.11.027. Epub 2009 Dec 2.
Implantable cardioverter-defibrillator (ICD) shocks have been associated with an increased risk of death. It is unknown whether this is due to the ventricular arrhythmia (VA) or shocks and whether antitachycardia pacing (ATP) termination can reduce this risk.
The purpose of this study was to determine whether mortality in ICD patients is influenced by the type of therapy (shocks of ATP) delivered.
Cox models evaluated effects of baseline characteristics, ventricular tachycardia (VT; <188 bpm), fast VT (FVT; 188-250 bpm), ventricular fibrillation (VF; >250 bpm), and therapy type (shocks or ATP) on mortality among 2135 patients in four trials of ATP to reduce shocks.
Over 10.8 +/- 3.3 months, 24.3% patients received appropriate shocks (50.6%) or ATP only (49.4%), and 6.6% died. Mortality predictors were age (hazard ratio 1.07, 95% confidence interval 1.04-1.08, P <.0001), New York Heart Association class III/IV (3.50 [2.27-5.41]; P <.0001), coronary disease (3.08 [1.31-7.25]; P = .01), and cumulative VA (VT + FVT + VF) episodes shocked (1.20 [1.13, 1.29]; P <.0001). Beta-blockers (0.65, 0.46-0.92; P <.0001) and remote myocardial infarction (0.53, [0.38-0.76] P = .0004) predicted reduced risk. Since 92% of VT and all VF received a single therapy type (ATP and shocks, respectively), the effect of therapy on episode risk could not be established. For FVT (32% shocked, 68% ATP), episode and therapy effects could be uncoupled; ATP-terminated FVT did not increase episode mortality risk, whereas shocked FVT increased risk by 32%. Survival rates were highest among patients with no VA (93.8%) of ATP-only (94.7%) and lowest for shocked patients (88.4%). Monthly episode rates were 80% higher among shocked versus ATP-only patients.
Shocked VA episodes are associated with increased mortality risk. Shocked patients have substantially higher VA episode burden and poorer survival compared with ATP-only-treated patients.
植入式心脏复律除颤器 (ICD) 电击与死亡风险增加有关。目前尚不清楚这是由于室性心律失常 (VA) 还是电击引起的，以及抗心动过速起搏 (ATP) 是否可以降低这种风险。
本研究旨在确定 ICD 患者的死亡率是否受治疗类型（电击或 ATP）的影响。
Cox 模型评估了基线特征、室性心动过速 (VT；<188 bpm)、快速 VT (FVT；188-250 bpm)、心室颤动 (VF；>250 bpm) 和治疗类型（电击或 ATP）对 4 项 ATP 降低电击临床试验中 2135 名患者死亡率的影响。
在 10.8+/-3.3 个月期间，24.3%的患者接受了适当的电击 (50.6%) 或仅接受 ATP (49.4%)，6.6%的患者死亡。死亡率预测因素为年龄 (风险比 1.07，95%置信区间 1.04-1.08，P<.0001)、纽约心脏协会 III/IV 级 (3.50 [2.27-5.41]；P<.0001)、冠心病 (3.08 [1.31-7.25]；P=.01) 和电击的累积 VA (VT+FVT+VF)发作次数 (1.20 [1.13, 1.29]；P<.0001)。β受体阻滞剂 (0.65，0.46-0.92；P<.0001) 和远程心肌梗死 (0.53，[0.38-0.76]P=.0004) 预测风险降低。由于 92%的 VT 和所有 VF 接受了单一的治疗类型 (ATP 和电击，分别)，因此无法确定治疗对发作风险的影响。对于 FVT(32%电击，68%ATP)，发作和治疗的影响可以分开；ATP 终止的 FVT 不会增加发作的死亡率风险，而电击的 FVT 则增加了 32%的风险。无 VA (ATP 仅为 94.7%) 和电击患者的生存率最高 (93.8%)，电击患者的生存率最低 (88.4%)。与 ATP 治疗患者相比，电击患者的 VA 发作负担更高，生存率更低。
电击 VA 发作与死亡风险增加有关。与仅接受 ATP 治疗的患者相比，电击患者的 VA 发作负担更大，生存率更低。
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