一级预防植入式心律转复除颤器患者的晕厥

Syncope in Primary Prevention Implantable Cardioverter Defibrillator Patients.

作者信息

Goldenberg Gustavo, Bental Tamir, Kadmon Udi, Zabarsky Ronit, Kusnick Jairo, Barsheshet Alon, Golovchiner Gregory, Strasberg Boris

出版信息

Isr Med Assoc J. 2016 Jun;18(6):318-21.

PMID:27468522

Abstract

BACKGROUND

Syncope is a common clinical condition spanning from benign to life-threatening diseases. There is sparse information on the outcomes of syncopal patients who received an implantable cardiac defibrillator (lCD) for primary prevention of sudden cardiac death (SCD).

OBJECTIVES

To assess the outcomes and prognosis of patients who underwent implantable cardiac defibrillator (ICD) implantation for primary prevention of SCD and compare them to patients who presented with or without prior syncope.

METHODS

We compared the medical records of 75 patients who underwent ICD implantation for primary prevention of SCD and history of syncope to those of a similar group of 80 patients without prior syncope. We assessed the episodes of ventricular tachycardia (VT), ventricular fibrillation (VF), shock, anti-tachycardia pacing (ATP) and mortality in each group during follow-up.

RESULTS

Mean follow-up was 893 days (810-976, 95% CI) (no difference between groups). There was no significant difference in gender or age. Patients with prior syncope had a higher ejection fraction rate (35.5 ? 12.6 vs. 31.4 8.76, P = 0.02), experienced more episodes of VT (21.3% vs. 3.8%, P = 0.001) and VF (8% vs. 0%, P = 0.01), and received more electric shocks (18.7% vs. 3.8%, P = 0.004) and ATP (17.3% vs. 6.2%, P = 0.031). There were no differences in inappropriate shocks (6.7% vs. 5%, P = 0.74), cardiovascular mortality (cumulative 5 year estimate 29.9% vs. 32.2%, P = 0.97) and any death (cumulative 5 year estimate 38.1% vs. 48.9%, P = 0.18).

CONCLUSIONS

Patients presenting with syncope before ICD implantation seemed to have more episodes of VT/VF and shock or ATP. No differences in mortality were observed.

摘要

背景

晕厥是一种常见的临床病症，涵盖从良性到危及生命的多种疾病。关于接受植入式心脏除颤器（ICD）用于心脏性猝死（SCD）一级预防的晕厥患者的预后信息较少。

目的

评估接受植入式心脏除颤器（ICD）植入以进行SCD一级预防的患者的预后，并将其与有或无既往晕厥史的患者进行比较。

方法

我们将75例因SCD一级预防且有晕厥病史而接受ICD植入的患者的病历与80例无既往晕厥史的类似患者组的病历进行了比较。我们评估了随访期间每组中心室性心动过速（VT）、心室颤动（VF）、电击、抗心动过速起搏（ATP）发作情况及死亡率。

结果

平均随访时间为893天（810 - 976，95%可信区间）（两组间无差异）。性别和年龄无显著差异。有既往晕厥史的患者射血分数率较高（35.5±12.6 vs. 31.4±8.76，P = 0.02），经历更多的VT发作（21.3% vs. 3.8%，P = 0.001）和VF发作（8% vs. 0%，P = 0.01），接受更多的电击（18.7% vs. 3.8%，P = 0.004）和ATP（17.3% vs. 6.2%，P = 0.031）。不适当电击（6.7% vs. 5%，P = 0.74）、心血管死亡率（5年累积估计值29.9% vs. 32.2%，P = 0.97）和任何原因死亡（5年累积估计值38.1% vs. 48.9%，P = 0.18）方面无差异。