Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, Leiden, the Netherlands.
J Am Coll Cardiol. 2011 Nov 22;58(22):2282-9. doi: 10.1016/j.jacc.2011.08.038.
The purpose of this study was to evaluate the impact of upgrading implantable cardioverter-defibrillator (ICD) therapy to cardiac resynchronization therapy (CRT) combined with defibrillator (CRT-D) on the occurrence of ventricular arrhythmia (VA) and appropriate ICD therapies.
CRT has been shown to improve left ventricular (LV) systolic function and induce reverse LV remodeling. In addition, it has been hypothesized that CRT may reduce the incidence of VA.
Heart failure patients receiving an upgrade from ICD to CRT-D were evaluated. Patients were considered responders to CRT if LV end-systolic volume reduced ≥15% at 6 months of follow-up. Episodes of VA, triggering device therapy (anti-tachycardia pacing and shocks) were recorded before and after upgrade for the overall population. In addition, these outcomes were compared between CRT responders and nonresponders during the follow-up period after CRT response was assessed.
One hundred fifteen patients (93 males [81%], age 65 ± 12 years) were evaluated during a mean follow-up of 54 ± 34 months before CRT-D upgrade and 37 ± 27 months after upgrade. In CRT responders (n = 70), the frequency of VA requiring appropriate device therapy demonstrated a trend toward a decrease from 0.51 ± 0.79 to 0.30 ± 0.59 per patient per year after CRT-D upgrade (p = 0.052). In CRT nonresponders (n = 45), the frequency of VA requiring appropriate device therapy significantly increased from 0.40 ± 0.69 to 1.21 ± 2.53 per patient per year after CRT-D upgrade (p = 0.014).
After upgrade from ICD to CRT-D, nonresponders to CRT showed a significant increase in VA burden requiring appropriate device therapy.
本研究旨在评估将植入式心脏复律除颤器（ICD）升级为心脏再同步治疗（CRT）联合除颤器（CRT-D）对室性心律失常（VA）和适当的 ICD 治疗的发生的影响。
CRT 已被证明可改善左心室（LV）收缩功能并诱导 LV 逆重构。此外，有人假设 CRT 可能会降低 VA 的发生率。
评估了从 ICD 升级为 CRT-D 的心力衰竭患者。如果在 6 个月的随访中 LV 收缩末期容积减少≥15%，则认为患者对 CRT 有反应。在升级前后，记录了整个人群的 VA 发作和触发设备治疗（抗心动过速起搏和电击）。此外，在 CRT 反应评估后的随访期间，还比较了 CRT 反应者和无反应者之间的这些结局。
在 CRT-D 升级前平均随访 54±34 个月和升级后 37±27 个月，对 115 名患者（93 名男性[81%]，年龄 65±12 岁）进行了评估。在 CRT 反应者（n=70）中，在升级后，需要适当设备治疗的 VA 频率从 CRT-D 升级前的 0.51±0.79 次/患者/年降至 CRT-D 升级后的 0.30±0.59 次/患者/年，呈下降趋势（p=0.052）。在 CRT 无反应者（n=45）中，在升级后，需要适当设备治疗的 VA 频率从 CRT-D 升级前的 0.40±0.69 次/患者/年显著增加至 CRT-D 升级后的 1.21±2.53 次/患者/年（p=0.014）。
从 ICD 升级为 CRT-D 后，对 CRT 无反应者的 VA 负担显著增加，需要适当的设备治疗。
