Boulé Stéphane, Sémichon Marc, Guédon-Moreau Laurence, Drumez Élodie, Kouakam Claude, Marquié Christelle, Brigadeau François, Kacet Salem, Potelle Charlotte, Escande William, Souissi Zouheir, Lacroix Dominique, Duhamel Alain, Klug Didier
Department of Cardiovascular Medicine, Lille University Hospital, 59370 Lille, France; Faculty of Medicine, University of Lille 2, 59000 Lille, France.
Department of Cardiovascular Medicine, Lille University Hospital, 59370 Lille, France.
Arch Cardiovasc Dis. 2016 Oct;109(10):517-526. doi: 10.1016/j.acvd.2016.02.008. Epub 2016 Jun 21.
Little is known about the long-term outcomes of patients who receive an implantable cardioverter-defibrillator (ICD) for purely secondary prevention indications.
To assess the rates and predictors of appropriate therapies over a very long-term follow-up period in this population.
Between June 2003 and August 2006, 239 consecutive patients with structural left ventricular disease and a secondary prophylaxis indication for ICD therapy (survivors of life-threatening ventricular tachyarrhythmias) were prospectively enrolled. An extended follow-up of these patients was carried out. The primary endpoint was the occurrence of appropriate device therapy. Secondary endpoints were all-cause death, electrical storm and inappropriate therapy.
The study population consisted of 239 patients (90% men; mean age 64±12 years; 72% ischaemic cardiomyopathy; left ventricular ejection fraction 37±12%). During a median follow-up of 7.8 (3.5-9.3) years, appropriate device therapy occurred in 139 (58.2%) patients. Death occurred in 141 patients (59%), electrical storm in 73 (30.5%) and inappropriate therapy in 42 (17.6%). Multivariable analysis identified patients whose presenting arrhythmia was ventricular fibrillation as being less likely to require appropriate device therapy than those whose presenting arrhythmia was ventricular tachycardia (sub-hazard ratio 0.62, 95% confidence interval 0.40-0.97; P=0.04). Independent predictors of all-cause death were age at implantation (P<0.0001), wide QRS complexes (P=0.024), creatinine concentration (P=0.0002) and B-type natriuretic peptide at implantation (P=0.0001).
Secondary prevention ICD recipients exhibit a high risk of appropriate device therapy and death over prolonged follow-up. Patients who presented initially with ventricular fibrillation were less likely to require the delivery of appropriate device therapy.
对于因单纯二级预防指征而接受植入式心律转复除颤器（ICD）治疗的患者的长期预后了解甚少。
评估该人群在非常长期的随访期内恰当治疗的发生率及预测因素。
在2003年6月至2006年8月期间，前瞻性纳入了239例连续的有左心室结构疾病且有ICD治疗二级预防指征（危及生命的室性快速心律失常幸存者）的患者。对这些患者进行了延长随访。主要终点是恰当的器械治疗的发生情况。次要终点是全因死亡、电风暴和不恰当治疗。
研究人群包括239例患者（90%为男性；平均年龄64±12岁；72%为缺血性心肌病；左心室射血分数37±12%）。在中位随访7.8（3.5 - 9.3）年期间，139例（58.2%）患者发生了恰当的器械治疗。141例患者（59%）死亡，73例（30.5%）发生电风暴，42例（17.6%）发生不恰当治疗。多变量分析确定，与初始心律失常为室性心动过速的患者相比，初始心律失常为心室颤动的患者需要恰当器械治疗的可能性较小（亚风险比0.62，95%置信区间0.40 - 0.97；P = 0.04）。全因死亡的独立预测因素为植入时年龄（P < 0.0001）、宽QRS波群（P = 0.024）、肌酐浓度（P = 0.0002）和植入时B型利钠肽（P = 0.0001）。
二级预防ICD接受者在长期随访中显示出较高的恰当器械治疗和死亡风险。初始表现为心室颤动的患者需要进行恰当器械治疗的可能性较小。
