心脏再同步治疗超反应者中的室性心律失常

Ventricular arrhythmias in super-responders to cardiac resynchronization therapy.

作者信息

García-Lunar Inés, Castro-Urda Víctor, Toquero-Ramos Jorge, Mingo-Santos Susana, Moñivas-Palomero Vanessa, Daniela Mitroi Cristina, Sánchez-García Manuel, Pérez-Pereira Elena, Delgado Hugo E, Fernández-Lozano Ignacio

机构信息

Unidad de Arritmias, Servicio de Cardiología, Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda, Madrid, Spain; Servicio de Cardiología, Hospital Universitario Quirón, Universidad Europea de Madrid, Madrid, Spain; Fundación Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain.

Unidad de Arritmias, Servicio de Cardiología, Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda, Madrid, Spain.

出版信息

Rev Esp Cardiol (Engl Ed). 2014 Nov;67(11):883-9. doi: 10.1016/j.rec.2014.01.016. Epub 2014 Jun 4.

DOI:10.1016/j.rec.2014.01.016

PMID:25443812

Abstract

INTRODUCTION AND OBJECTIVES

Cardiac resynchronization therapy is associated with improved quality of life and reduced morbidity and mortality in patients with severe ventricular dysfunction and wide QRS. However, its role in the reduction of ventricular arrhythmias is more controversial.

METHODS

We compared the incidence of ventricular arrhythmias in patients who were undergoing cardiac resynchronization therapy with an implantable cardioverter-defibrillator in terms of the degree of echocardiographic response to resynchronization. Patients were classified in 3 subgroups;super-responders, responders, and nonresponders.

RESULTS

We included 196 patients who were followed up for a median 30.1 months [interquartile range, 18.0-55.1 months]. We recorded the presence of ventricular arrhythmias in 37 patients (18.8%); 3 patients (5.9%) in the super-responder group had ventricular arrhythmias vs 14 (22.2%) among the responders and 20 (24.4%) in the group of nonresponders (P = .025). In multivariate analysis, the only independent predictors of the appearance of ventricular arrhythmias were secondary-prevention device implantation (odds ratio = 4.04; 95% confidence interval, 1.52-10.75; P=.005), absence of echocardiographic super-response (odds ratio=3.81; 95% confidence interval, 1.04-13.93; P=043), QRS >160 ms (odds ratio=2.39; 95% confidence interval, 1.00-1.35; P=.049) and treatment with amiodarone (odds ratio=2.47; 95% confidence interval, 1.03-5.91; P=.041).

CONCLUSIONS

The patients classified as super-responders to cardiac resynchronization therapy had a significant reduction in incidence of ventricular arrhythmias by comparison with the other patients. Despite this, arrhythmic episodes do not completely disappear in this subgroup.

摘要

引言与目的

心脏再同步治疗可改善严重心室功能不全和QRS波增宽患者的生活质量，降低发病率和死亡率。然而，其在减少室性心律失常方面的作用更具争议性。

方法

我们根据心脏再同步治疗的超声心动图反应程度，比较了接受心脏再同步治疗并植入植入式心脏复律除颤器患者的室性心律失常发生率。患者分为3个亚组：超反应者、反应者和无反应者。

结果

我们纳入了196例患者，中位随访时间为30.1个月[四分位间距，18.0 - 55.1个月]。我们记录到37例患者（18.8%）出现室性心律失常；超反应者组中有3例患者（5.9%）出现室性心律失常，反应者组中有14例（22.2%），无反应者组中有20例（24.4%）（P = 0.025）。在多变量分析中，室性心律失常出现的唯一独立预测因素是二级预防装置植入（比值比 = 4.04；95%置信区间，1.52 - 10.75；P = 0.005）、无超声心动图超反应（比值比 = 3.81；95%置信区间，1.04 - 13.93；P = 0.043）、QRS波>160 ms（比值比 = 2.39；95%置信区间，1.00 - 1.35；P = 0.049）以及使用胺碘酮治疗（比值比 = 2.47；95%置信区间，1.03 - 5.91；P = 0.041）。