心脏移植患者心律失常特征及临床结局的长期随访

Long-term follow-up of arrhythmia characteristics and clinical outcomes in heart transplant patients.

作者信息

Chang H-Y, Lo L-W, Feng A-N, Chiang M-C, Yin W-H, Young M-S, Chang C-Y, Chuang Y-C, Hartono B, Chen S-A, Wei J

机构信息

Division of Cardiology, Cheng Hsin General Hospital, Taipei, Taiwan.

出版信息

Transplant Proc. 2013 Jan-Feb;45(1):369-75. doi: 10.1016/j.transproceed.2012.09.116.

DOI:10.1016/j.transproceed.2012.09.116

PMID:23375324

Abstract

INTRODUCTION

Arrhythmias occur frequently after heart transplantation (HT), but knowledge of their impact on long-term outcomes is limited. This study sought to investigate the characteristics of the arrhythmias among biatrial orthotopic HT patients during long-term follow-up.

METHODS

This study included 217 patients who received biatrial orthotopic HT. Patients were classified into 5 groups according to the arrhythmia episodes that occurred >1 month after HT: no arrhythmias (group 1; n = 149); atrial tachyarrhythmias only (group 2; n = 34); ventricular tachyarrhythmias only (group 3; n = 9); bradyarrhythmias only (group 4; n = 7); or double/triple arrhythmias (group 5; n = 18). We analyzed their long-term outcomes respectively.

RESULTS

During 83 ± 51 months of follow-up, all-cause mortality rates were higher in groups 3 (88.9%) and 5 (72.2%) compared with the other groups (groups 1, 2, and 4: 21.5%, 41.2%, and 57.1%, respectively; P < .001). Cardiovascular mortality rates were higher in groups 4 (42.9%) and 5 (61.1%) compared with the other groups (groups 1, 2, and 3: 8.1%, 20.6%, and 0% respectively; P < .001). Noncardiovascular mortality rate was greater in group 3 (88.9%) compared with the other groups (groups 1, 2, 4, and 5: 13.4%, 20.6%, 14.3%, and 11.1%, respectively; P < .001). Sudden death rates were higher in groups 4 (42.9%) and 5 (44.4%) compared with the other groups (groups 1, 2, and 3: 7.4%, 8.8%, and 0%, respectively; P < .001).

CONCLUSION

Patients with posttransplantation arrhythmias experienced significantly worse clinical outcomes.

摘要

引言

心脏移植（HT）后心律失常频繁发生，但关于其对长期预后影响的了解有限。本研究旨在调查双心房原位心脏移植患者长期随访期间心律失常的特征。

方法

本研究纳入了217例接受双心房原位心脏移植的患者。根据心脏移植后1个月以上发生的心律失常发作情况，将患者分为5组：无心律失常（第1组；n = 149）；仅房性快速性心律失常（第2组；n = 34）；仅室性快速性心律失常（第3组；n = 9）；仅缓慢性心律失常（第4组；n = 7）；或双重/三重心律失常（第5组；n = 18）。我们分别分析了他们的长期预后。

结果

在83±51个月的随访期间，与其他组（第1、2和4组，分别为21.5%、41.2%和57.1%）相比，第3组（88.9%）和第5组（72.2%）的全因死亡率更高（P <.001）。与其他组（第1、2和3组，分别为8.1%、20.6%和0%）相比，第4组（42.9%）和第5组（61.1%）的心血管死亡率更高（P <.001）。与其他组（第1、2、4和5组，分别为13.4%、20.6%、14.3%和11.1%）相比，第3组（88.9%）的非心血管死亡率更高（P <.001）。与其他组（第1组、2组和3组，分别为7.4%、8.8%和0%）相比，第4组（42.9%）和第5组（44.4%）的猝死率更高（P <.001）。