心脏淀粉样变患者的植入式心脏复律除颤器。

Implantable cardioverter defibrillators in patients with cardiac amyloidosis.

机构信息

Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA.

出版信息

J Cardiovasc Electrophysiol. 2013 Jul;24(7):793-8. doi: 10.1111/jce.12123. Epub 2013 Mar 14.

DOI:10.1111/jce.12123

PMID:23489983

Abstract

BACKGROUND

Cardiac amyloidosis (CA) is associated with increased risk of sudden cardiac arrest. Although ICD therapy improves survival in patients with cardiomyopathy due to other etiologies, the benefit of ICD therapy in patients with CA is unclear in large part due to limited data on the precise mechanism of sudden cardiac arrest and selection of patients with cardiac amyloidosis for ICD therapy.

OBJECTIVE

The objective was to determine the benefit of ICD therapy in cardiac amyloidosis.

METHODS

We reviewed all ICD implant indications, procedures, and therapies, of CA patients evaluated at Mayo Clinic between 2000 and 2009.

RESULTS

A total of 53 patients with CA (33 AL, 10 senile, 9 familial, and 1 AA) who underwent ICD implantation were included. Indication for ICD implantation was for primary prevention of sudden cardiac arrest in 41 (77%) patients and secondary prevention in 12 (23%) patients. The rate of appropriate ICD shocks was 32% in the first year and was observed almost exclusively in AL amyloidosis patients, occurring in 15 patients (12 AL amyloidosis, 2 senile, 1 AA). Appropriate ICD shocks were more frequent in patients with prior sudden cardiac arrest or sustained ventricular arrhythmias (secondary prevention indication), and less frequent in patients who presented with decreased ejection fraction or syncope.

CONCLUSIONS

A high rate of appropriate ICD shocks was observed especially in patients with AL-type amyloidosis. However, appropriate ICD therapy did not translate into overall survival benefit, suggesting that selection of patients with CA who might be candidates for ICD is imprecise.

摘要

背景

心脏淀粉样变性（CA）与心脏骤停的风险增加有关。尽管 ICD 治疗可改善其他病因引起的心肌病患者的生存率，但由于关于心脏淀粉样变性患者心脏骤停的确切机制和 ICD 治疗患者选择的有限数据，ICD 治疗在心脏淀粉样变性患者中的益处尚不清楚。

目的

目的是确定 ICD 治疗在心脏淀粉样变性中的益处。

方法

我们回顾了 2000 年至 2009 年期间在 Mayo 诊所接受评估的 CA 患者的所有 ICD 植入指征、程序和治疗方法。

结果

共纳入 53 例 CA（33 例 AL，10 例老年，9 例家族性，1 例 AA）患者行 ICD 植入。ICD 植入的指征是为 41 例（77%）患者进行原发性预防心脏骤停和为 12 例（23%）患者进行二级预防。第一年 ICD 适当电击的发生率为 32%，几乎仅见于 AL 淀粉样变性患者，在 15 例患者中发生（12 例 AL 淀粉样变性，2 例老年，1 例 AA）。适当的 ICD 电击在有先前心脏骤停或持续性室性心律失常（二级预防指征）的患者中更为常见，在射血分数降低或晕厥的患者中较少发生。