Lelakowski Jacek, Rydlewska Anna, Lelakowska Maria, Pudło Joanna, Piekarz Justyna
Jagiellonian University, Institute of Cardiology, Department of Electrocardiology, The John Paul II Hospital in Kraków.
Department of Coronary Disease and Heart Failure, The John Paul II Hospital in Kraków.
Pol Merkur Lekarski. 2017 Feb 20;42(248):65-70.
The task of the ICD is to detect ventricular arrhythmias and treatment of its adequate intervention. The task of the CRTD in addition to the above tasks is the treatment of heart failure.
The aim of the study was to assess the predictive parameters of adequate interventions in patients with an ICD and CRTD.
The study consisted of 273 patients (230 M, mean age 65±11 years) with ICD and/or CRTD. The inclusion criteria were: left ventricle ejection fraction (LVEF) ≤ 35%, NYHA class ≥ II, implantation in primary SCD prevention and in case of CRTD additionally LBBB with wide QRS ≥ 120ms. The following data were assessed: age, gender, presence of dilated cardiomyopathy, diabetes, chronic kidney failure, atrial fibrillation (AF), LVEF, NYHA class, device interventions, number of arrhythmias, changes in pharmacotherapy, device parameters and mortality.
During observation, which lasted the mean of 770±490 days, 102 patients had adequate device interventions. In the ICD group, adequate interventions appear mainly in the initial observation period (HR 2,01), in patients with left ventricular hypertrophy (HR 2,98) and ventricular arrhythmias (HR 6,78) and not treated with amiodarone (HR 4,31). In the CRTD group, adequate interventions appear mainly in younger patients (HR 1,06), in diabetes (HR 1,68), in NYHA class II, in paroxysmal atrial fibrillation (HR 1,09) and ventricular arrhythmias (HR 2,54) and not treated with amiodarone (HR 1,09).
In the ICD group, left ventricular hypertrophy, ventricular arrhythmias is not treated with amiodarone in a significant influence on the risk of adequate intervention. In the Group of CRTD younger age, diabetes, NYHA class II, paroxysmal atrial fibrillation, ventricular arrhythmias is not treated with amiodarone in a significant influence on the risk of adequate intervention. In the ICD group, adequate interventions particularly often in the first year of follow-up. Patients with CRTD require special medical care.
植入式心律转复除颤器（ICD）的任务是检测室性心律失常并进行适当的干预治疗。心脏再同步化治疗除颤器（CRTD）除上述任务外，还包括治疗心力衰竭。
本研究旨在评估植入ICD和CRTD患者进行适当干预的预测参数。
本研究纳入273例植入ICD和/或CRTD的患者（230例男性，平均年龄65±11岁）。纳入标准为：左心室射血分数（LVEF）≤35%，纽约心脏协会（NYHA）心功能分级≥Ⅱ级，用于一级心脏性猝死（SCD）预防植入，若为CRTD还需伴有左束支传导阻滞且QRS波增宽≥120ms。评估以下数据：年龄、性别、扩张型心肌病的存在情况、糖尿病、慢性肾衰竭、心房颤动（AF）、LVEF、NYHA心功能分级、设备干预情况、心律失常次数、药物治疗变化、设备参数及死亡率。
在平均持续770±490天的观察期内，102例患者进行了适当的设备干预。在ICD组中，适当干预主要出现在初始观察期（风险比[HR]2.01）、左心室肥厚患者（HR 2.98）、室性心律失常患者（HR 6.78）以及未使用胺碘酮治疗的患者中（HR 4.31）。在CRTD组中，适当干预主要出现在较年轻患者中（HR 1.06）、糖尿病患者中（HR 1.68）、NYHA心功能分级Ⅱ级患者中、阵发性心房颤动患者中（HR 1.09）、室性心律失常患者中（HR 2.54）以及未使用胺碘酮治疗的患者中（HR 1.09）。
在ICD组中，左心室肥厚、未使用胺碘酮治疗的室性心律失常对适当干预风险有显著影响。在CRTD组中，较年轻、糖尿病、NYHA心功能分级Ⅱ级、阵发性心房颤动、未使用胺碘酮治疗的室性心律失常对适当干预风险有显著影响。在ICD组中，适当干预尤其常在随访的第一年出现。CRTD患者需要特殊的医疗护理。
