Köbe Julia, Wasmer Kristina, Andresen Dietrich, Kleemann Thomas, Spitzer Stefan G, Jehle Joachim, Brachmann Johannes, Stellbrink Christoph, Hochadel Matthias, Senges Jochen, Klein Helmut U, Eckardt Lars
Department of Cardiology and Angiology, Division of Electrophysiology, University Hospital of Muenster, Germany.
Int J Cardiol. 2013 Oct 9;168(4):4184-90. doi: 10.1016/j.ijcard.2013.07.110. Epub 2013 Aug 12.
Outcome data of patients with implantable cardioverter defibrillators (ICD) and atrial fibrillation (AF) are conflicting. The German DEVICE registry aims to add further information on this particular cohort.
The German DEVICE registry is a nationwide prospective multicenter database of ICD implantations. 3261 patients are included (81% males, 2701 (82.8%) first ICD implantations, 560 (17.2%) ICD replacements). Cardiac resynchronization therapy (CRT-D) was performed in 882 patients (27.0%). Sinus rhythm (SR) was present in 2654 (81.4%) and atrial fibrillation (AF) in 607 (18.6%). Left ventricular ejection fraction (LVEF) did not differ between groups (SR 32.3%, AF 30.4%; p = 0.09). AF patients were older (AF 70.9 versus SR 63.9 years; p < 0.0001), presented with more co-morbidities (diabetes, hypertension, chronic kidney disease; all p < 0.001). In-hospital complications were not significantly different between groups (p = 0.58). Follow-up information after one year was available in 2967 patients (91%). One-year overall mortality after first ICD implantation was 4.9% for SR and 11.2% for AF patients (p < 0.0001); mortality one year after ICD replacement was 8.4% for SR and 12.0% for AF (p = 0.34). No statistically significant difference between SR and AF patients receiving a CRT device was observed (SR 6.9%, AF 10.7%, p = 0.16) in terms of one-year mortality.
The German DEVICE registry demonstrates that patients with AF who receive ICD devices are older, have more co-morbidity and more severe heart failure. AF carries an independent 1.39 fold risk (95% CI 1.02-1.89) of death after one year in patients only with first ICD implantation.
植入式心脏复律除颤器（ICD）患者与心房颤动（AF）患者的预后数据存在矛盾。德国DEVICE注册研究旨在补充这一特定队列的更多信息。
德国DEVICE注册研究是一个全国性的ICD植入前瞻性多中心数据库。纳入3261例患者（81%为男性，2701例（82.8%）首次植入ICD，560例（17.2%）更换ICD）。882例患者（27.0%）接受了心脏再同步治疗（CRT-D）。2654例（81.4%）为窦性心律（SR），607例（18.6%）为心房颤动（AF）。两组间左心室射血分数（LVEF）无差异（SR组32.3%，AF组30.4%；p = 0.09）。AF患者年龄更大（AF组70.9岁，SR组63.9岁；p < 0.0001），合并症更多（糖尿病、高血压、慢性肾脏病；均p < 0.001）。两组间院内并发症无显著差异（p = 0.58）。2967例患者（91%）有1年的随访信息。首次植入ICD后1年，SR患者的总死亡率为4.9%，AF患者为11.2%（p < 0.0001）；更换ICD后1年，SR患者的死亡率为8.4%，AF患者为12.0%（p = 0.34）。在接受CRT设备的SR和AF患者中，1年死亡率方面未观察到统计学显著差异（SR组6.9%，AF组10.7%，p = 0.16）。
德国DEVICE注册研究表明，接受ICD设备的AF患者年龄更大，合并症更多，心力衰竭更严重。仅首次植入ICD的患者中，AF患者1年后死亡风险独立增加1.39倍（95%CI 1.02 - 1.89）。
