Department of Cardiology and Angiology, Division of Experimental and Clinical Electrophysiology, University Hospital Münster, Münster, Germany.
Europace. 2012 Mar;14(3):396-401. doi: 10.1093/europace/eur316. Epub 2011 Oct 6.
The use of implantable cardioverter defibrillators (ICD) in patients with torsade de pointes (TdP) and ventricular fibrillation in the presence of acquired long QT syndrome (aLQTS) is under debate, partly due to the fact that aLQTS is potentially reversible and currently no long-term follow-up data are available. We aimed to evaluate the long-term follow-up of patients with acquired long QT syndrome (aLQTS) who had received an implantable cardioverter defibrillator (ICD) for secondary prevention of sudden cardiac arrest (SCA).
Over a 10 year period, 43 patients with an ICD after survived cardiac arrest (SCA) due to an aLQTS were included [female n= 27 (63%); mean age 61 ± 16 years]. There was no clinical evidence for congenital LQTS (Schwartz score 1.25 ± 0.8). Structural heart disease was present in 29 patients (47%; ischaemic n= 13; dilated cardiomyopathy n= 9; mean EF 41%± 12). The most common proarrhythmic trigger happened to be antiarrhythmic drugs (n= 34; 79%). Other triggers included contrast agent (n= 1), haloperidol (n= 2), severe hypokalaemia (n= 2), drug abuse/alcohol (n= 2), and mere severe bradycardia (n= 2). Under trigger QTc interval measured 536 ± 58 vs. 438 ± 33 ms without trigger (P< 0.001). During a mean follow-up of 84 ± 55 months, appropriate shocks occurred in 19 patients (44%); inappropriate shocks in 13 patients (30%; only inappropriate n= 3). Appropriate shocks were almost as common in patients without as in those with structural heart disease (35 vs. 48%; P= 0.32). None of the patients were re-exposed to the initial trigger during the follow-up period. Beta-blocker medication did not prevent ICD shocks (12 of 19 vs. 11 of 24 on medication).
Appropriate ICD shocks are a common finding in patients with aLQTS and SCA irrespective of the underlying cause or structural heart disease. Thus, even in the presence of relevant acquired proarrhythmia ICD may be beneficial.
在获得性长 QT 综合征（aLQTS）存在的情况下，使用植入式心脏复律除颤器（ICD）治疗尖端扭转型室性心动过速（TdP）和心室颤动存在争议，部分原因是 aLQTS 具有潜在的可逆性，目前尚无长期随访数据。我们旨在评估接受植入式心脏复律除颤器（ICD）二级预防心脏性猝死（SCA）的获得性长 QT 综合征（aLQTS）患者的长期随访情况。
在 10 年期间，纳入了 43 例因 aLQTS 导致心脏骤停（SCA）后接受 ICD 的患者[女性 n=27（63%）；平均年龄 61 ± 16 岁]。无先天性长 QT 综合征的临床证据（Schwartz 评分 1.25 ± 0.8）。29 例患者存在结构性心脏病（47%；缺血性 n=13；扩张型心肌病 n=9；平均 EF 41%±12）。最常见的致心律失常触发因素是抗心律失常药物（n=34；79%）。其他触发因素包括造影剂（n=1）、氟哌啶醇（n=2）、严重低钾血症（n=2）、药物滥用/酒精（n=2）和单纯严重心动过缓（n=2）。在触发状态下，QTc 间期为 536 ± 58 ms，无触发时为 438 ± 33 ms（P<0.001）。在平均 84 ± 55 个月的随访期间，19 例患者（44%）发生了适当的电击；13 例患者（30%）发生了不适当的电击（仅不适当电击 n=3）。无结构性心脏病患者和有结构性心脏病患者的适当电击发生率相似（35%与 48%；P=0.32）。在随访期间，没有患者再次接触到初始触发因素。β受体阻滞剂治疗并不能预防 ICD 电击（19 例中有 12 例 vs. 24 例中有 11 例用药）。
无论潜在病因或结构性心脏病如何，aLQTS 和 SCA 患者中适当的 ICD 电击都是常见现象。因此，即使存在相关的获得性致心律失常，ICD 也可能有益。
