心脏再同步治疗对轻度心力衰竭患者室性心律失常发生率的影响。
The impact of cardiac resynchronization therapy on the incidence of ventricular arrhythmias in mild heart failure.
机构信息
Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina 29425-5920, USA.
出版信息
Heart Rhythm. 2011 May;8(5):679-84. doi: 10.1016/j.hrthm.2010.12.031. Epub 2010 Dec 23.
BACKGROUND
Cardiac resynchronization therapy (CRT) decreases mortality, improves functional status, and induces reverse left ventricular (LV) remodeling in selected populations. However, the effect of CRT on ventricular arrhythmias is controversial. This is particularly important among patients with mild heart failure (HF), in whom sudden death is a leading cause of mortality.
OBJECTIVE
This study sought to assess the impact of CRT on ventricular arrhythmias in mild HF.
METHODS
The REsynchronization reVErses Remodeling in Systolic left vEntricular dysfunction (REVERSE) study is a multicenter randomized, double-blind trial of CRT among patients with mild systolic HF. The time to first appropriate, treated ventricular tachycardia/ventricular fibrillation (VT/VF) episode or spontaneous sustained VT in cardiac resynchronization therapy plus defibrillation device (CRT-D) patients was compared between groups, as were predictors of VT/VF.
RESULTS
The study randomized 508 patients who received CRT-D devices. There were no significant demographic differences between groups. There were no differences in VT/VF episodes or VT storm between groups. Specifically, in the CRT ON group, the estimated event rate was 18.7% at 2 years, compared with 21.9% in the CRT OFF group (hazard ratio 1.05, P = .84). However, among CRT ON patients, those with reverse remodeling had a reduced incidence of VT/VF compared with those without remodeling (5.6% vs. 16.3%, hazard ratio 0.31, P = .001).
CONCLUSION
CRT for up to 2 years does not impact VT/VF in mild HF despite marked clinical and remodeling effects of pacing. This neutral effect may be attributable to competing antiarrhythmic effects of reverse remodeling and proarrhythmic effect of pacing.
CLINICAL TRIAL REGISTRATION
背景
心脏再同步治疗（CRT）可降低死亡率、改善功能状态，并使特定人群的左心室（LV）逆向重构。然而，CRT 对室性心律失常的影响存在争议。在轻度心力衰竭（HF）患者中，尤其是在猝死是主要死亡原因的患者中，这一点尤为重要。
目的
本研究旨在评估 CRT 对轻度 HF 患者室性心律失常的影响。
方法
REsynchronization reVErses Remodeling in Systolic left vEntricular dysfunction（REVERSE）研究是一项多中心、随机、双盲 CRT 临床试验，纳入了轻度收缩性 HF 患者。比较 CRT 联合除颤装置（CRT-D）患者组间首次恰当治疗的室性心动过速/心室颤动（VT/VF）发作或自发性持续性 VT 的时间，以及 VT/VF 的预测因素。
结果
该研究共纳入 508 例接受 CRT-D 装置治疗的患者。两组间无显著的人口统计学差异。两组间 VT/VF 发作或 VT 风暴无差异。具体而言，在 CRT 开启组中，2 年时的估计事件发生率为 18.7%，而 CRT 关闭组为 21.9%（风险比 1.05，P =.84）。然而，在 CRT 开启患者中，与无重构患者相比，逆向重构患者 VT/VF 的发生率降低（5.6% vs. 16.3%，风险比 0.31，P =.001）。
结论
尽管起搏有明显的临床和重构作用，但在轻度 HF 中，长达 2 年的 CRT 并不影响 VT/VF。这种中性效应可能归因于逆向重构的抗心律失常作用和起搏的致心律失常作用之间的竞争。
Zotero 插件