First Department of Medicine-Cardiology, University Medical Centre and Faculty of Medicine Mannheim, University of Heidelberg, Mannheim, Germany.
Clin Cardiol. 2011 Oct;34(10):604-9. doi: 10.1002/clc.20949. Epub 2011 Sep 1.
Implantable cardioverter-defibrillator (ICD) therapy for primary prevention is well established in ischemic cardiomyopathy (ICM). Data on the role of ICDs in patients with dilated cardiomyopathy (DCM) and no history of ventricular tachyarrhythmia (VT/VF) are more limited.
DCM patients with an impaired left ventricular ejection fraction (LVEF) still represent a low arrhythmic risk subgroup in clinical practice.
ICD stored data of DCM patients with an LVEF ≤35% was compared to data of ICM patients meeting Multicenter Automatic Defibrillator Implantation Trial (MADIT) eligibility criteria. VT/VF occurrences and electrical storm (ES) events were analyzed.
There were 652 patients followed for 50.9 ± 33.9 months. There were 1978 VT and 241 VF episodes analyzed in 66 out of 203 patients (32.5%) with DCM and in 118 out of 449 patients (26.3%, P = 0.209) with ICM. Freedom of appropriate ICD treatment due to VT/VF or ES events did not differ in both patient populations (log-rank, P>0.05). In patients presenting with VT/VF episodes, mean event rates were comparable in both patient populations (3.2 ± 14.1 for DCM and VT vs 3 ± 13.9 for ICM and VT [P = 0.855], 0.4 ± 1.3 for DCM and VF vs 0.4 ± 1.8 for ICM and VF [P = 0.763], and 0.2 ± 0.7 for DCM and ES vs 0.2 ± 1 for ICM and ES [P = 0.666]).
DCM patients with prophylactic ICDs implanted due to heart failure and patients fulfilling MADIT criteria reveal comparable patterns of VT/VF/ES events during long-term follow-up. Incidence, mean number of events, and time to first event did not differ significantly. Findings support the current guidelines for prophylactic ICD therapy in DCM patients with heart failure.
植入式心脏复律除颤器（ICD）治疗在缺血性心肌病（ICM）中的一级预防已得到充分证实。在没有室性心动过速/心室颤动（VT/VF）病史的扩张型心肌病（DCM）患者中，ICD 的作用的数据则更为有限。
在临床实践中，左心室射血分数（LVEF）降低的 DCM 患者仍代表一个心律失常风险较低的亚组。
比较 LVEF≤35%的 DCM 患者的 ICD 储存数据与符合多中心自动除颤器植入试验（MADIT）入选标准的 ICM 患者的数据。分析 VT/VF 发作和电风暴（ES）事件。
共有 652 例患者接受了 50.9±33.9 个月的随访。在 203 例患者中的 66 例（32.5%）和 449 例患者中的 118 例（26.3%，P=0.209）患有 DCM，共分析了 1978 次 VT 和 241 次 VF 发作。在这两个患者群体中，由于 VT/VF 或 ES 事件而接受适当 ICD 治疗的无事件生存率没有差异（对数秩检验，P>0.05）。在出现 VT/VF 发作的患者中，两个患者群体的平均事件发生率相当（DCM 和 VT 为 3.2±14.1，ICM 和 VT 为 3.0±13.9 [P=0.855]，DCM 和 VF 为 0.4±1.3，ICM 和 VF 为 0.4±1.8 [P=0.763]，DCM 和 ES 为 0.2±0.7，ICM 和 ES 为 0.2±1.0 [P=0.666]）。
由于心力衰竭而植入预防性 ICD 的 DCM 患者和符合 MADIT 标准的患者在长期随访中表现出相似的 VT/VF/ES 事件模式。发生率、平均事件数和首次事件时间无显著差异。这些发现支持当前心力衰竭 DCM 患者预防性 ICD 治疗的指南。
