Baumert Mathias, Kabir Muammar M, Dalouk Khidir, Henrikson Charles A, Tereshchenko Larisa G
School of Electrical and Electronic Engineering, The University of Adelaide, Adelaide, Australia.
Pacing Clin Electrophysiol. 2015 May;38(5):547-57. doi: 10.1111/pace.12594. Epub 2015 Mar 9.
In heart failure patients with implantable cardioverter defibrillator (ICD) the risk of death from causes other than tachyarrhythmia is substantial. Benefit from ICD is determined by two competing risks: appropriate ICD shock or nonarrhythmic death. The goal of the study was to test predictors of competing outcomes.
Patients with structural heart disease (N = 234, mean age 58.5 ± 15.1; 71% men, 80% whites, 61% ischemic cardiomyopathy) and primary (75%) or secondary prevention ICD underwent a 5-minute baseline near-field electrogram (NF EGM) recording. VV' alternans triplets were quantified as a percentage of three sinus VV' cycles sequences of "short-long-short" or "long-short-long" order. Appropriate ICD shock for fast ventricular tachycardia (FVT, cycle length ≤240 ms)/ventricular fibrillation (VF) and composite nonarrhythmic death (pump failure death or heart transplant) served as competing outcomes.
Over a median follow-up of 2.4 years, 26 patients (4.6% per person-year of follow-up) developed FVT/VF with ICD shock, and 35 (6.3% per person-year of follow-up) had nonarrhythmic death. In competing risk analysis, after adjustment for demographics, left ventricular ejection fraction, New York Heart Association class, cardiomyopathy type, use of class I antiarrhythmics, and diabetes, increased percentage of VV' alternans triplets (>69%) was associated with nonarrhythmic death (subhazard ratio [SHR] 2.09; 95% confidence interval [CI] 1.03-4.23; P = 0.041), rather than with FVT/VF (SHR 1.05; 95% CI 0.45-2.46; P = 0.901). Risk of nonarrhythmic death was especially high in diabetics with VV' alternans triplets in the highest quartile (SHR 3.46; 95% CI 1.41-8.50; P = 0.007).
In ICD patients with structural heart disease sinus VV' alternans triplets on NF EGM is independently associated with nonarrhythmic death, rather than with FVT/VF.
在植入式心脏复律除颤器（ICD）的心力衰竭患者中，非快速心律失常原因导致的死亡风险很高。ICD的获益由两种相互竞争的风险决定：ICD恰当电击或非心律失常性死亡。本研究的目的是检验相互竞争结局的预测因素。
患有结构性心脏病的患者（N = 234，平均年龄58.5±15.1岁；71%为男性，80%为白人，61%为缺血性心肌病）以及接受一级（75%）或二级预防ICD的患者进行了5分钟的基线近场心电图（NF EGM）记录。VV'交替三联律被量化为“短-长-短”或“长-短-长”顺序的三个窦性VV'周期序列的百分比。针对快速室性心动过速（FVT，周期长度≤240毫秒）/心室颤动（VF）的恰当ICD电击以及复合性非心律失常性死亡（泵衰竭死亡或心脏移植）作为相互竞争的结局。
在中位随访2.4年期间，26例患者（随访期间每人每年4.6%）发生FVT/VF并接受ICD电击，35例患者（随访期间每人每年6.3%）发生非心律失常性死亡。在竞争风险分析中，在对人口统计学、左心室射血分数、纽约心脏协会分级、心肌病类型、I类抗心律失常药物的使用以及糖尿病进行校正后，VV'交替三联律百分比增加（>69%）与非心律失常性死亡相关（亚风险比[SHR] 2.09；95%置信区间[CI] 1.03 - 4.23；P = 0.041），而与FVT/VF无关（SHR 1.05；95% CI 0.45 - 2.46；P = 0.901）。在最高四分位数的具有VV'交替三联律的糖尿病患者中，非心律失常性死亡风险尤其高（SHR 3.46；95% CI 1.41 - 8.50；P = 0.007）。
在患有结构性心脏病的ICD患者中，NF EGM上的窦性VV'交替三联律与非心律失常性死亡独立相关，而非与FVT/VF相关。
