Piekarz Justyna, Rydlewska Anna, Majewski Jacek, Lelakowski Jacek
Jagiellonian University, School of Medicine, Cracow, Poland, Institute of Cardiology, Department of Electrocardiology, The John Paul II Hospital in Krakow, Poland.
Pol Merkur Lekarski. 2012 Jun;32(192):368-73.
Antitachycardia pacing (ATP) and high voltage interventions (CV) are methods of interrupting dangerous ventricular arrhythmias. The aim of the study was to determine the frequency of ventricular tachyarrhythmias and form of ICD interventions in patients in the primary and secondary sudden cardiac death (SCD) prevention groups.
The study involved 399 patients (334 male, 65 female), mean age was 65.2 +/- 12.1 years (21-89 years), who had an ICD implanted in years 2008-2010. The analysis comprised age, gender, indications for ICD implantation, intracardiac electrograms derived from ICD during the follow-up.
The patients were divided in 2 groups depending on the SCD prevention type: group A - primary prevention, group B - secondary prevention. In the A group, the peak death rate was in the 7th decade of life, while in the B group it was 10 years later. In the A group the main condition was coronary arteries disease (CAD) (76%) and dilating non-ischemic cardiomiopathy (18%), whilst in the B group, only CAD (100%). In the A group different forms of ventricular tachyarrhythmias were registered more often in the dead (57%), than living patients (38%). The difference was statistically significant (p < 0.025) and considered mainly ventricular fibrillation observed in 21% of dead patients and only in 4,2% living. Despite the fact, that in the B group the percentage of dangerous ventricular tachyarrhythmias (VT and especially VF) was higher, there were fewer deaths than in A group (7.8 vs 12.8%). In living patients in the B group, there were registered twice as many ICD interventions as in the A group. In the A group, in patients over 70 years old, in contrary to the younger, more frequently ventricular tachyarrhythmias and antiarrhythmic interventions (ATP, CV) were observed. In the B group, the relation was reversed. Inadequate and ineffective interventions occurred mainly in the A group.
There were twice as many ICD interventions in patients implanted in secondary SCD prevention than in patients implanted in primary prevention. In secondary prevention, in contrary to the primary, the frequency of ventricular tachyarrhythmias and ICD interventions in patients younger than 70 years old is higher than in older patients. The most frequent reason for inadequate ICD interventions are sinus tachycardia and atrial fibrillation.
抗心动过速起搏（ATP）和高电压干预（CV）是中断危险室性心律失常的方法。本研究的目的是确定一级和二级心脏性猝死（SCD）预防组患者室性快速心律失常的发生率以及植入式心律转复除颤器（ICD）干预的形式。
本研究纳入了399例患者（男性334例，女性65例），平均年龄为65.2±12.1岁（21 - 89岁），他们于2008 - 2010年植入了ICD。分析内容包括年龄、性别、ICD植入指征以及随访期间从ICD获取的心内电图。
根据SCD预防类型将患者分为两组：A组 - 一级预防，B组 - 二级预防。在A组中，死亡率高峰出现在70岁年龄段，而在B组中则晚10年。在A组中，主要疾病是冠状动脉疾病（CAD）（76%）和扩张型非缺血性心肌病（18%），而在B组中，仅CAD（100%）。在A组中，不同形式的室性快速心律失常在死亡患者中出现的频率（57%）高于存活患者（38%）。差异具有统计学意义（p < 0.025），主要是因为在21%的死亡患者中观察到心室颤动，而存活患者中仅为4.2%。尽管B组中危险室性快速心律失常（室性心动过速，尤其是心室颤动）的百分比更高，但死亡人数比A组少（7.8%对12.8%）。在B组的存活患者中，ICD干预的次数是A组的两倍。在A组中，70岁以上患者与年轻患者相比，更频繁地出现室性快速心律失常和抗心律失常干预（ATP，CV）。在B组中，这种关系相反。不适当和无效的干预主要发生在A组。
二级SCD预防植入患者的ICD干预次数是一级预防植入患者的两倍。在二级预防中，与一级预防相反，70岁以下患者室性快速心律失常和ICD干预的频率高于老年患者。ICD干预不适当的最常见原因是窦性心动过速和心房颤动。
