Fogoros R N, Elson J J, Bonnet C A
Division of Cardiology, Medical College of Pennsylvania, Allegheny General Hospital, Pittsburgh 15212.
Pacing Clin Electrophysiol. 1989 Sep;12(9):1465-73. doi: 10.1111/j.1540-8159.1989.tb06151.x.
The actuarial incidence and pattern of occurrence of shocks were analyzed in 65 patients after implantation of the automatic implantable cardioverter defibrillator. During a mean follow-up of 25 +/- 21 months only one patient died suddenly, and this patient had a nonfunctioning device at the time of death. The long-term actuarial risk of death from any cause in the patients who received appropriate shocks was not significantly different than for the entire group. The 1- and 4-year cumulative risk of receiving any shock was 51 +/- 7% and 81 +/- 11%; of receiving an appropriate shock was 33 +/- 7% and 64 +/- 10%; of receiving a spurious shock was 17 +/- 5% and 21 +/- 6%; and of receiving an "indeterminate" shock was 19 +/- 6% and 52 +/- 10%. In 14 patients who were followed for 24 months without receiving an appropriate shock, the actuarial risk of receiving an appropriate shock was 29 +/- 14% during the next 24 months. The mean number of shocks delivered during appropriate episodes was 1.6 +/- 0.9, which was significantly lower than the mean of 4.0 +/- 2.0 shocks during spurious episodes (P less than 0.02). The mean number of shocks during indeterminate episodes was 1.7 +/- 1.5. Our data confirms the efficacy of the implantable defibrillator in preventing sudden death. The majority of patients with this device receive appropriate shocks during long-term follow-up, and the cumulative incidence of appropriate shocks increases steadily for at least 4 years. In contrast, the cumulative incidence of spurious shocks plateaus at about 12 months. Our data suggests that many "indeterminate" shocks actually appear to be appropriate.
对65例植入自动植入式心脏复律除颤器的患者的电击发生率及发生模式进行了分析。在平均25±21个月的随访期内，仅1例患者突然死亡，该患者死亡时装置无功能。接受适当电击的患者中任何原因导致的长期死亡精算风险与整个组相比无显著差异。接受任何电击的1年和4年累积风险分别为51±7%和81±11%；接受适当电击的风险分别为33±7%和64±10%；接受误放电击的风险分别为17±5%和21±6%；接受“不确定”电击的风险分别为19±6%和52±10%。在14例随访24个月未接受适当电击的患者中，未来24个月接受适当电击的精算风险为29±14%。适当电击发作期间的平均电击次数为1.6±0.9次，显著低于误放电击发作期间的平均4.0±2.0次（P<0.02）。不确定电击发作期间的平均电击次数为1.7±1.5次。我们的数据证实了植入式除颤器在预防猝死方面的有效性。该装置的大多数患者在长期随访期间接受了适当的电击，并且适当电击的累积发生率至少4年稳步上升。相比之下，误放电击的累积发生率在约12个月时趋于平稳。我们的数据表明，许多“不确定”电击实际上似乎是适当的。
