Department of Cardiology, Leiden University Medical Center, the Netherlands.
J Am Coll Cardiol. 2011 Feb 1;57(5):556-62. doi: 10.1016/j.jacc.2010.06.059.
The purpose of this study was to assess the incidence, predictors, and outcome of inappropriate shocks in implantable cardioverter-defibrillator (ICD) patients.
Despite the benefits of ICD therapy, inappropriate defibrillator shocks continue to be a significant drawback. The prognostic importance of inappropriate shocks outside the setting of a clinical trial remains unclear.
From 1996 to 2006, all recipients of defibrillator devices equipped with intracardiac electrogram storage were included in the current analysis and clinically assessed at implantation. During follow-up, the occurrence of inappropriate ICD shocks and all-cause mortality was noted.
A total of 1,544 ICD patients (79% male, age 61 ± 13 years) were included in the analysis. During the follow-up period of 41 ± 18 months, 13% experienced ≥1 inappropriate shocks. The cumulative incidence steadily increased to 18% at 5-year follow-up. Independent predictors of the occurrence of inappropriate shocks included a history of atrial fibrillation (hazard ratio [HR]: 2.0, p < 0.01) and age younger than 70 years (HR: 1.8, p = 0.01). Experiencing a single inappropriate shock resulted in an increased risk of all-cause mortality (HR: 1.6, p = 0.01). Mortality risk increased with every subsequent shock, up to an HR of 3.7 after 5 inappropriate shocks.
In a large cohort of ICD patients, inappropriate shocks were common. The most important finding is the association between inappropriate shocks and mortality, independent of interim appropriate shocks.
本研究旨在评估植入式心脏复律除颤器（ICD）患者中不适当电击的发生率、预测因素和转归。
尽管 ICD 治疗有其益处，但不适当的电击仍然是一个重大缺陷。在临床试验之外，不适当电击的预后重要性仍不清楚。
1996 年至 2006 年，所有接受配备心内电图存储设备的除颤器装置的患者均包括在当前分析中，并在植入时进行临床评估。在随访期间，记录不适当 ICD 电击和全因死亡率的发生情况。
共纳入 1544 例 ICD 患者（79%为男性，年龄 61±13 岁）进行分析。在 41±18 个月的随访期间，13%的患者经历了≥1 次不适当电击。累积发生率在 5 年随访时稳步增加至 18%。不适当电击发生的独立预测因素包括心房颤动史（危险比[HR]：2.0，p<0.01）和年龄小于 70 岁（HR：1.8，p=0.01）。经历单次不适当电击会增加全因死亡率的风险（HR：1.6，p=0.01）。随着随后每次电击的发生，死亡率风险增加，在经历 5 次不适当电击后，风险增加至 3.7。
在大型 ICD 患者队列中，不适当电击很常见。最重要的发现是不适当电击与死亡率之间的关联，与中期适当电击无关。
