From the Department of Medicine, Division of Cardiology (G.M.O., C.T., W.W., B.M., A.B., D.P.J., H.T., H.C., C.A.J.) and Department of Radiology (I.R.K., S.L.Z.), Johns Hopkins Hospital, Baltimore, MD; and Department of Heart and Lungs, Division of Cardiology, University Medical Center Utrecht, and Netherlands Heart Institute (A.t.R.).
Circ Arrhythm Electrophysiol. 2018 Feb;11(2):e005593. doi: 10.1161/CIRCEP.117.005593. Epub 2018 Feb 16.
Ventricular arrhythmias are a feared complication of arrhythmogenic right ventricular dysplasia/cardiomyopathy. In 2015, an International Task Force Consensus Statement proposed a risk stratification algorithm for implantable cardioverter-defibrillator placement in arrhythmogenic right ventricular dysplasia/cardiomyopathy.
To evaluate performance of the algorithm, 365 arrhythmogenic right ventricular dysplasia/cardiomyopathy patients were classified as having a Class I, IIa, IIb, or III indication per the algorithm at baseline. Survival free from sustained ventricular arrhythmia (VT/VF) in follow-up was the primary outcome. Incidence of ventricular fibrillation/flutter cycle length <240 ms was also assessed. Two hundred twenty-four (61%) patients had a Class I implantable cardioverter-defibrillator indication; 80 (22%), Class IIa; 54 (15%), Class IIb; and 7 (2%), Class III. During a median 4.2 (interquartile range, 1.7-8.4)-year follow-up, 190 (52%) patients had VT/VF and 60 (16%) had ventricular fibrillation/flutter. Although the algorithm appropriately differentiated risk of VT/VF, incidence of VT/VF was underestimated (observed versus expected: 29.6 [95% confidence interval, 25.2-34.0] versus >10%/year Class I; 15.5 [confidence interval 11.1-21.6] versus 1% to 10%/year Class IIa). In addition, the algorithm did not differentiate survival free from ventricular fibrillation/flutter between Class I and IIa patients (=0.97) or for VT/VF in Class I and IIa primary prevention patients (=0.22). Adding Holter results (<1000 premature ventricular contractions/24 hours) to International Task Force Consensus classification differentiated risks.
While the algorithm differentiates arrhythmic risk well overall, it did not distinguish ventricular fibrillation/flutter risks of patients with Class I and IIa implantable cardioverter-defibrillator indications. Limited differentiation was seen for primary prevention cases. As these are vital uncertainties in clinical decision-making, refinements to the algorithm are suggested prior to implementation.
室性心律失常是致心律失常性右室心肌病的一种可怕并发症。2015 年，国际专家组共识声明提出了一种用于心律失常性右室心肌病患者植入式心脏复律除颤器（ICD）-placement 的风险分层算法。
为了评估该算法的性能，365 名致心律失常性右室心肌病患者在基线时根据该算法被分类为 I 类、IIa 类、IIb 类或 III 类指征。主要终点是随访期间无持续性室性心律失常（VT/VF）的生存。还评估了心室颤动/扑动周期长度<240ms 的发生率。224 名（61%）患者有 I 类 ICD 指征；80 名（22%）为 IIa 类；54 名（15%）为 IIb 类；7 名（2%）为 III 类。在中位 4.2 年（四分位距，1.7-8.4 年）的随访期间，190 名（52%）患者发生 VT/VF，60 名（16%）患者发生心室颤动/扑动。尽管该算法适当地区分了 VT/VF 的风险，但 VT/VF 的发生率被低估（观察到的与预期的：29.6%[95%置信区间，25.2-34.0] vs >10%/年 I 类；15.5%[置信区间 11.1-21.6%] vs 1%至 10%/年 IIa 类）。此外，该算法不能区分 I 类和 IIa 类患者的无室颤/扑动生存（=0.97），或 I 类和 IIa 类原发性预防患者的 VT/VF 生存（=0.22）。将 Holter 结果（<1000 个室性期前收缩/24 小时）添加到国际专家组共识分类中可以区分风险。
尽管该算法总体上能很好地区分心律失常风险，但它不能区分 I 类和 IIa 类 ICD 指征患者的室颤/扑动风险。对原发性预防病例的区分有限。由于这些是临床决策中的重要不确定性，建议在实施前对算法进行改进。
Zotero 插件