Hospital General Universitario Gregorio Marañon, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Calle Dr. Esquerdo 46, 28007 Madrid, Spain.
Hospital Universitario de Araba, Vitoria, Spain.
Europace. 2017 Nov 1;19(11):1818-1825. doi: 10.1093/europace/euw303.
Cardiac resynchronization therapy (CRT) reduces the incidence of sudden cardiac death and the use of appropriate implantable cardioverter-defibrillator (ICD) therapies (AICDTs); however, this antiarrhythmic effect is only observed in certain groups of patients. To gain insight into the effects of CRT on ventricular arrhythmia (VA) burden, we compared the incidence of AICDT use in four groups of patients: patients with ischaemic cardiomyopathy vs. non-ischaemic dilated cardiomyopathy (NIDC) and patients implanted with an ICD vs. CRT-ICD.
We analysed 689 consecutive patients (mean follow-up 37 ± 16 months) included in the Umbrella registry, a multicentre prospective registry including patients implanted with ICD or CRT-ICD devices with remote monitoring capabilities in 48 Spanish Hospitals. The primary outcome was the time to first AICDT. Despite a worse clinical risk profile, NIDC patients receiving a CRT-ICD had a lower cumulative probability of first AICDT use at 2 years compared with patients implanted with an ICD [24.7 vs. 41.6%, hazard ratio (HR): 0.49, P = 0.003]; on the other hand, there were no significant differences in the incidence of first AICDT use at 2 years in ischaemic patients (22.6 vs. 21.9%, P = NS). Multivariate analysis confirmed the association of CRT with lower AICDT rates amongst NIDC patients (Adjusted HR: 0.55, CI 95% 0.35-0.87).
These data suggest that CRT is associated with significantly lower rates of first AICDT use in NIDC patients, but not in ischaemic patients. This study suggests that ICD patients with NIDC and left bundle branch block experiencing VAs may benefit from an upgrade to CRT-ICD despite being in a good functional class.
心脏再同步治疗（CRT）可降低心脏性猝死和适当植入式心脏复律除颤器（ICD）治疗（AICDT）的发生率；然而，这种抗心律失常作用仅在某些患者群体中观察到。为了深入了解 CRT 对室性心律失常（VA）负担的影响，我们比较了 4 组患者中 AICDT 使用的发生率：缺血性心肌病患者与非缺血性扩张型心肌病（NIDC）患者和植入 ICD 与 CRT-ICD 的患者。
我们分析了 Umbrella 注册研究中的 689 例连续患者（平均随访 37±16 个月），该多中心前瞻性注册研究纳入了 48 家西班牙医院中具有远程监测功能的 ICD 或 CRT-ICD 设备植入患者。主要结局是首次 AICDT 的时间。尽管临床风险状况较差，但与植入 ICD 的患者相比，接受 CRT-ICD 的 NIDC 患者在 2 年内首次 AICDT 使用的累积概率较低[24.7%比 41.6%，风险比（HR）：0.49，P=0.003]；另一方面，在缺血性患者中，2 年内首次 AICDT 使用的发生率无显著差异[22.6%比 21.9%，P=NS]。多变量分析证实 CRT 与 NIDC 患者 AICDT 发生率降低相关（调整 HR：0.55，95%CI 0.35-0.87）。
这些数据表明，CRT 与 NIDC 患者首次 AICDT 使用的发生率显著降低相关，但与缺血性患者无关。这项研究表明，尽管功能状态良好，NIDC 和左束支传导阻滞伴 VA 的 ICD 患者可能受益于升级为 CRT-ICD。
