在左心室功能不全的植入式心脏复律除颤器患者中，β受体阻滞剂治疗与快速室性心动过速所致晕厥的发生率较低相关：一项多中心研究的结果
Beta-blocker therapy is associated with a lower incidence of syncope due to fast ventricular tachycardias among implantable cardioverter-defibrillator patients with left ventricular dysfunction: results from a multicenter study.
作者信息
Jiménez-Candil Javier, Anguera Ignasi, Durán Olga, Hernández Jesús, Fernández-Portales Javier, Moríñigo José Luis, Martín Ana, Dallaglio Paolo, Bravo Loreto, di Marco Andrea, Sánchez Pedro Luis
机构信息
Cardiology Department, IBSAL-University Hospital, School of Medicine, University of Salamanca, CIVERCV, Salamanca, Paseo de San Vicente 58-182, 37007, Salamanca, Spain.
Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.
出版信息
J Interv Card Electrophysiol. 2018 Jun;52(1):69-76. doi: 10.1007/s10840-018-0344-0. Epub 2018 Mar 20.
INTRODUCTION
Among implantable cardioverter-defibrillator (ICD) patients, a substantial proportion of syncopes are due to fast ventricular tachycardias (FVTs). In the experimental models of ventricular tachycardias, the arterial vasoconstriction plays an important role in recovering the arterial pressure. Since beta-blockers increase vascular resistance, we hypothesized that beta-blockers could reduce the occurrence of syncope due to FVTs. Our objective was to determine the relationship between the beta-blocker therapy and the incidence of syncope in FVT (cycle length [CL] 250-320 ms) occurring in ICD patients. Slow VTs were excluded because of the lack of symptoms and VF episodes because of the small number.
METHODS AND RESULTS
In this multicenter study, 226 patients (LVEF 31 ± 10%) with single-chamber ICDs were followed. FVT programming was standardized, including antitachycardia pacing (ATP) as initial therapy. Symptoms were correlated with ICD-stored episode data of FVTs. The beta-blocker therapy was determined at each FVT presentation. We analyzed 289 FVTs (CL 291 ± 21 ms; 77% under beta-blockers; median of the duration:8 s) occurring consecutively in 52 ICD patients. The frequency of FVT-related syncope was 22 (7.6%). Beta-blockers were associated with a lower heart rate preceding FVT (85 ± 22 vs. 94 ± 23 bpm; p = 0.009), a higher ATP effectiveness (86 vs. 57%; p < 0.001), a lower duration of episodes (8 [2] vs. 10 [14] s; p < 0.001), and a lower incidence of FVT-related syncope (4.5 vs. 18%; p < 0.001). By logistic regression, a FVT > 8 s (OR = 21; p = 0.003) and the beta-blocker therapy (OR = 0.3; p = 0.012) were found as independent predictors of syncope.
CONCLUSION
Among ICD patients with left ventricular dysfunction, beta-blockers are associated with a lower incidence of FVT-related syncope.
引言
在植入式心脏复律除颤器（ICD）患者中，相当一部分晕厥是由快速室性心动过速（FVT）引起的。在室性心动过速的实验模型中，动脉血管收缩在恢复动脉压方面起着重要作用。由于β受体阻滞剂会增加血管阻力，我们推测β受体阻滞剂可以减少因FVT导致的晕厥发生。我们的目的是确定β受体阻滞剂治疗与ICD患者中发生的FVT（周期长度[CL]250 - 320毫秒）所致晕厥发生率之间的关系。由于症状不明显而排除了缓慢室性心动过速，且因数量较少而排除了室颤发作。
方法与结果
在这项多中心研究中，对226例单腔ICD患者（左心室射血分数[LVEF]31±10%）进行了随访。FVT程控标准化，包括将抗心动过速起搏（ATP）作为初始治疗。症状与ICD存储的FVT发作数据相关。在每次FVT发作时确定β受体阻滞剂治疗情况。我们分析了52例ICD患者连续发生的289次FVT（CL 291±21毫秒；77%发生在使用β受体阻滞剂期间；持续时间中位数：8秒）。FVT相关晕厥的发生率为22次（7.6%）。β受体阻滞剂与FVT发作前较低的心率（85±22对94±23次/分；p = 0.009）、较高的ATP有效性（86%对57%；p < 0.001）、较短的发作持续时间（8[2]对10[14]秒；p < 0.001）以及较低的FVT相关晕厥发生率（4.5%对18%；p < 0.001）相关。通过逻辑回归分析，发现FVT发作持续时间>8秒（比值比[OR]=21；p = 0.003）和β受体阻滞剂治疗（OR = 0.3；p = 0.012）是晕厥的独立预测因素。
结论
在左心室功能不全的ICD患者中，β受体阻滞剂与FVT相关晕厥的较低发生率相关。
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