心泰美二代（HeartMate II）早期植入期的电风暴：发生率、危险因素和预后。
Electrical storm in the early phase of HeartMate II device implantation: Incidence, risk factors and prognosis.
机构信息
Service de rythmologie, hôpital cardiologique du Haut-Lévêque, 1, avenue Magellan, 33600 Pessac, France.
Service d'insuffisance cardiaque, hôpital cardiologique du Haut-Lévêque, 33600 Pessac, France.
出版信息
Arch Cardiovasc Dis. 2018 May;111(5):332-339. doi: 10.1016/j.acvd.2017.07.006. Epub 2017 Dec 6.
BACKGROUND
Ventricular arrhythmia is common after left ventricular assist device (LVAD) implantation, especially in the early postoperative phase (<30 days).
AIM
To identify the incidence of and risk factors for electrical storm (ES) occurring within 30 days of HeartMate II implantation.
METHODS
We reviewed data from all consecutive patients undergoing HeartMate II device implantation at our institution from January 2008 to December 2014. Patient demographic data, pharmacotherapies and outcomes were collected. The primary endpoint was occurrence of early ES (within 30 days of surgery), defined as three or more separate episodes of sustained ventricular arrhythmia within a 24-hour interval, requiring appropriate therapy.
RESULTS
Forty-three patients (mean age 56.7±11.2 years; 39 men) were included. At HeartMate II implantation, mean left ventricular ejection fraction was 20±5%, 32 (74.4%) patients had ischaemic cardiomyopathy and 31 (72.1%) were implanted with an indication of bridge to cardiac transplantation. During follow-up, 12 (27.9%) patients experienced early ES after HeartMate II implantation (median delay 9.1±7.8 days). Early ES was more frequent in larger patients (body surface area 1.99 vs 1.81 m; P<0.01), tended to be associated with previous sustained ventricular tachycardia (50.0% vs 22.6%; P=0.08), previous implantable cardioverter-defibrillator implantation (66.7% vs 38.7%; P=0.09), discontinuation of long-term beta-blocker therapy (75.0% vs 45.2%; P=0.08), weaning of adrenergic drugs after the third day (66.7% vs 35.5%; P=0.06) and the use of extracorporeal life support (50% vs 22.6%; P=0.079), but was not associated with the cardiomyopathy aetiology or the indication for assistance. Catheter ventricular tachycardia ablation was performed in six (14.0%) patients. Early ES was associated with a significantly higher all-cause mortality rate at the 30th day (33.3% vs 6.5%; P=0.02).
CONCLUSION
ES is a common and pejorative feature in the early postoperative period.
背景
左心室辅助装置（LVAD）植入后常发生室性心律失常，尤其是在术后早期（<30 天）。
目的
确定 HeartMate II 植入后 30 天内电风暴（ES）的发生率和危险因素。
方法
我们回顾了 2008 年 1 月至 2014 年 12 月期间在我院接受 HeartMate II 装置植入的所有连续患者的数据。收集患者的人口统计学数据、药物治疗和结果。主要终点是术后 30 天内早期 ES（手术 30 天内）的发生，定义为在 24 小时内出现三次或三次以上持续室性心律失常，需要适当的治疗。
结果
43 例患者（平均年龄 56.7±11.2 岁；39 例男性）入选。在 HeartMate II 植入时，平均左心室射血分数为 20±5%，32 例（74.4%）患者有缺血性心肌病，31 例（72.1%）患者因桥接心脏移植而植入。在随访期间，12 例（27.9%）患者在 HeartMate II 植入后发生早期 ES（中位延迟时间为 9.1±7.8 天）。体型较大的患者（体表面积 1.99 与 1.81 m；P<0.01）早期 ES 更为常见，与既往持续性室性心动过速（50.0%与 22.6%；P=0.08）、既往植入式心脏复律除颤器植入（66.7%与 38.7%；P=0.09）、长期β受体阻滞剂治疗中断（75.0%与 45.2%；P=0.08）、第三天后去甲肾上腺素药物停药（66.7%与 35.5%；P=0.06）和体外生命支持的使用（50%与 22.6%；P=0.079）有关，但与心肌病病因或辅助治疗指征无关。6 例（14.0%）患者进行了导管室性心动过速消融术。早期 ES 与第 30 天全因死亡率显著升高相关（33.3%与 6.5%；P=0.02）。
结论
ES 是术后早期常见且预后不良的特征。
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