心脏再同步治疗的超强反应可减少适当的植入式心脏复律除颤器治疗。
Super-response to cardiac resynchronization therapy reduces appropriate implantable cardioverter defibrillator therapy.
机构信息
Department of Cardiovascular Diseases, Mayo Clinic, 200 First St SW, Rochester, MN, USA.
Davidai Arrhythmia Center, Leviev Heart Center, Sheba Medical Center, Tel Hashomer and Tel Aviv University, Emek HaEla St 1, Ramat Gan, Israel.
出版信息
Europace. 2018 Aug 1;20(8):1303-1311. doi: 10.1093/europace/eux235.
AIMS
To determine the frequency of implantable cardioverter defibrillator (ICD) therapy following cardiac resynchronization therapy (CRT-D) implantation in super and non-super responders and whether greater improvement in left ventricular (LV) function after CRT is associated with a reduced burden in ICD therapy.
METHODS AND RESULTS
This is a two-centre, retrospective study between January 2002 and September 2011. Patients were classified as non-super responders and super-responders based on the post-CRT ejection fraction (EF) of < 50% and ≥50%, respectively. Of 629 recipients of CRT-D, 37 (5.9%) were super-responders. Implantable cardioverter defibrillator follow-up was available for a mean duration of 6.2 ± 2.7 years. The 5-year rate of antitachycardia pacing (ATP) in super-responders was significantly lower than in non-super responders (2.7% vs. 22.1%, P = 0.004). Super-responders also had a lower 5-year rate of appropriate ICD shock compared with non-super responders (2.7% vs. 14.3%, P = 0.03). On multivariable analysis, factors associated with appropriate ICD therapy (ICD shock/ATP) include male gender (hazard ratio, HR 1.97, 95% confidence interval, 95% CI 1.15-3.35), secondary prevention indication (HR 2.09, 95% CI 1.13-3.85), increased baseline LV end-systolic diameter (HR 1.03 per mm, 95% CI 1.01-1.06) and higher baseline EF (HR 1.03 per %, 95% CI 1.00-1.06) while super-responder status was highly protective (HR 0.13, 95% CI 0.02-0.91).
CONCLUSION
Recipients of CRT-D that normalize their EF have very low rates of ventricular arrhythmias requiring appropriate ICD therapy compared with those that do not.
目的
确定心脏再同步治疗（CRT-D）后在超级和非超级反应者中植入式心脏复律除颤器（ICD）治疗的频率，以及 CRT 后左心室（LV）功能的更大改善是否与 ICD 治疗负担的降低相关。
方法和结果
这是一项 2002 年 1 月至 2011 年 9 月期间在两个中心进行的回顾性研究。根据 CRT 后射血分数（EF）<50%和≥50%，患者分别被分类为非超级反应者和超级反应者。在 629 例接受 CRT-D 的患者中，37 例（5.9%）为超级反应者。ICD 随访平均持续时间为 6.2±2.7 年。超级反应者的 5 年抗心动过速起搏（ATP）率明显低于非超级反应者（2.7%比 22.1%，P=0.004）。超级反应者的适当 ICD 电击治疗 5 年率也低于非超级反应者（2.7%比 14.3%，P=0.03）。多变量分析显示，与适当 ICD 治疗（ICD 电击/ATP）相关的因素包括男性（危险比，HR 1.97，95%置信区间，95%CI 1.15-3.35）、二级预防适应证（HR 2.09，95%CI 1.13-3.85）、基线 LV 末期收缩直径增加（每毫米 HR 1.03，95%CI 1.01-1.06）和基线 EF 较高（每增加 1% HR 1.03，95%CI 1.00-1.06），而超级反应者状态具有高度保护作用（HR 0.13，95%CI 0.02-0.91）。
结论
与不恢复 EF 的 CRT-D 接受者相比，恢复 EF 的 CRT-D 接受者需要适当 ICD 治疗的室性心律失常发生率非常低。
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