植入式心脏复律除颤器在肥厚型心肌病中的应用：患者结局、恰当和不恰当干预的发生率以及并发症。

Implantable cardioverter-defibrillators in hypertrophic cardiomyopathy: patient outcomes, rate of appropriate and inappropriate interventions, and complications.

机构信息

Department of Cardiology, Thoraxcenter, Erasmus MC, Postbus 2040, Rotterdam, The Netherlands.

出版信息

Am Heart J. 2013 Sep;166(3):496-502. doi: 10.1016/j.ahj.2013.06.009. Epub 2013 Jul 16.

DOI:10.1016/j.ahj.2013.06.009

PMID:24016499

Abstract

BACKGROUND

Sudden cardiac death (SCD) is the most devastating complication of hypertrophic cardiomyopathy (HCM), but this can be prevented by an implantable cardioverter-defibrillator (ICD). The aim of this study is to evaluate HCM patients with ICDs for primary or secondary prevention of SCD.

METHODS

The study population consisted of all HCM patients with an ICD in 2 tertiary referral clinics. End points during follow-up were total and cardiac mortality, appropriate and inappropriate ICD intervention, and device-related complications. Cox-regression analysis was performed to identify predictors of outcome.

RESULTS

ICDs were implanted in 134 patients with HCM (mean age 44 ± 17 years, 34% women, 4.2 ± 4.8 years follow-up). Annualized cardiac mortality rate was 3.4% per year and associated with New York Heart Association class III or IV (HR 5.2 [2.0-14, P = .002]) and cardiac resynchronization therapy (HR 6.3 [2.1-20, P = .02]). Appropriate ICD interventions occurred in 38 patients (6.8%/year) and was associated with implantation for secondary prevention of SCD (HR 4.0 [1.8-9.1], P = .001) and male gender (HR 3.3 [1.2-9.0], P = .02). Inappropriate ICD intervention occurred in 21 patients (3.7%/year) and in 20 patients device related complications were documented (3.6%/year).

CONCLUSION

ICDs successfully abort life-threatening arrhythmias in HCM patients at increased risk of SCD with an annualized intervention rate of 6.8% per year. End-stage heart failure is the main cause of mortality in these patients. The annualized rate of inappropriate ICD intervention was 3.7% per year, whereas device-related complications occurred 3.6% per year.

摘要

背景

心脏性猝死（SCD）是肥厚型心肌病（HCM）最具破坏性的并发症，但可通过植入式心脏复律除颤器（ICD）预防。本研究旨在评估接受 ICD 治疗的 HCM 患者是否能预防 SCD 发生。

方法

研究人群包括 2 家三级转诊诊所的所有 HCM 伴 ICD 患者。随访期间的终点为全因死亡率、心脏性死亡率、恰当及不恰当 ICD 干预和器械相关并发症。采用 Cox 回归分析识别预后的预测因素。

结果

ICD 植入于 134 例 HCM 患者（平均年龄 44 ± 17 岁，34%为女性，随访时间 4.2 ± 4.8 年）。每年的心脏性死亡率为 3.4%，与纽约心脏病协会（NYHA）心功能分级 III 或 IV 级（HR 5.2 [2.0-14，P =.002]）和心脏再同步治疗（CRT）（HR 6.3 [2.1-20，P =.02]）相关。38 例患者（6.8%/年）发生了恰当 ICD 干预，与 SCD 二级预防植入（HR 4.0 [1.8-9.1]，P =.001）和男性（HR 3.3 [1.2-9.0]，P =.02）相关。21 例患者（3.7%/年）发生了不恰当 ICD 干预，20 例患者发生了器械相关并发症（3.6%/年）。