Alpert Medical School of Brown University and the Cardiovascular Institute, Rhode Island, Miriam, and Newport Hospitals, Providence, Rhode Island.
Medtronic, Inc., Minneapolis, Minnesota.
Heart Rhythm. 2015 Aug;12(8):1728-36. doi: 10.1016/j.hrthm.2015.04.037. Epub 2015 Apr 28.
American Heart Association/Heart Rhythm Society recommendations restrict driving in implantable cardioverter-defibrillator patients for 6 months after implant for secondary prevention or primary prevention with an appropriate therapy (antitachycardia pacing or shock) for ventricular arrhythmias (VA).
The purpose of this study was to analyze implantable cardioverter-defibrillator therapy data to inform guideline recommendations on driving.
The OMNI Registry was queried for VA and assessed for the time course of appropriate therapies. A blind events committee adjudicated events. The Kaplan-Meier method was used to estimate event rates. A 7-day blanking period was used for each event of interest.
A total of 2262 patients (mean age 67 ± 12 years; mean left ventricular ejection fraction 28%) were enrolled; 1659 (73%) were men, and 1666 (74%) were implanted for primary prevention. Overall, 628 of 2255 patients (28%) received ≥1 appropriate therapy. The probability of receiving a subsequent appropriate therapy increased and occurred in a shorter time interval with each appropriate therapy. At 6 months, the likelihood of receiving a shock when the first VA was terminated by shock (30.0%) was 3 times the risk when the first VA was terminated by antitachycardia pacing (9.9%).
Each appropriate VA therapy is associated with an increased risk of a subsequent event that occurs, on average, in a time frame shorter than current guideline-based restrictions. A differential risk of shock is noted in those receiving antitachycardia pacing vs shock for the first appropriate VA. These findings may help to inform future clinical guideline and practice decisions related to driving.
美国心脏协会/心律协会的建议限制植入式心脏复律除颤器患者在植入后 6 个月内开车，以防室性心律失常（VA）的二级预防或一级预防有适当的治疗（抗心动过速起搏或电击）。
本研究旨在分析植入式心脏复律除颤器治疗数据，为指南关于驾驶的建议提供信息。
查询 OMNI 登记处 VA 的情况，并评估适当治疗的时间过程。盲法事件委员会对事件进行裁决。采用 Kaplan-Meier 方法估计事件发生率。对每一个感兴趣的事件使用 7 天的空白期。
共纳入 2255 例患者（平均年龄 67±12 岁；平均左心室射血分数 28%）；1659 例（73%）为男性，1666 例（74%）为一级预防植入。总的来说，2255 例患者中有 628 例（28%）接受了≥1 次适当治疗。接受后续适当治疗的可能性增加，且每次接受适当治疗的时间间隔更短。6 个月时，当首次 VA 被电击终止时接受电击的可能性（30.0%）是首次 VA 被抗心动过速起搏终止时的 3 倍（9.9%）。
每次适当的 VA 治疗都与随后发生的事件的风险增加有关，而这些事件平均发生在比当前基于指南的限制更短的时间框架内。对于首次接受适当 VA 治疗的患者，接受抗心动过速起搏与电击的风险存在差异。这些发现可能有助于为未来与驾驶相关的临床指南和实践决策提供信息。
