Lelakowski Jacek, Rydlewska Anna, Lelakowska Maria, Pudło Joanna, Piekarz Justyna, Matusik Paweł
Przegl Lek. 2017;74(4):157-62.
The assessment of factors influencing occurrence of adequate interventions of cardiac resynchronization therapy with cardioverter-defibrillator implanted in primary prevention of sudden cardiac death in dilative cardiomyopathy and percentage of biventricular pacing.
The function of cardiac resynchronization therapy with cardioverter-defibrillator (CRT-D) is to treat heart failure (HF) and to treat ventricular arrhythmia, if it occurs, with adequate intervention.
The aim of the study was to find predictors of adequate interventions and in how many patients biventricular pacing percentage decreases during the follow-up.
The study comprised of 228 patients (178 M, mean age 66±10, 31-89 years) with implanted CRTD. The following data were analyzed: age, sex, presence of dilative cardiomyopathy, diabetes mellitus, lowered creatinine clearance, atrial fibrillation (AF), LVEF, NYHA class, adequate interventions, number of arrhythmias, pharmacotherapy modifications, device parameters and mortality.
Mean ejection fraction of the left ventricle was 20.9±6.4, (10.0- 35%). During the mean follow up of 770±490 days in 84 (37%) patients adequate interventions of the device occurred. The adequate interventions concerned mainly patients with diabetes mellitus (HR 2.95), in NYHA class II, with paroxysmal atrial fibrillation (HR 2.15). In 39 patients (17%) the mean percentage of biventricular pacing was below 90%, and in 18 (8%) below 85%.
Diabetes mellitus, NYHA class II, paroxysmal atrial fibrillation have significantly increased the risk of adequate intervention. The most common causes of loss of biventricular pacing were: inappropriate AV delay, supraventricular arrhythmias and premature ventricular complexes. A significant correlation between low biventricular pacing percentage and the occurrence of supraventricular arrhythmias and adequate interventions was observed.
评估影响在扩张型心肌病心脏性猝死一级预防中植入心脏再同步化治疗除颤器（CRT-D）时充分干预发生情况的因素以及双心室起搏百分比。
心脏再同步化治疗除颤器（CRT-D）的功能是治疗心力衰竭（HF），并在发生室性心律失常时进行充分干预。
本研究的目的是找出充分干预的预测因素以及在随访期间有多少患者的双心室起搏百分比下降。
本研究包括228例植入CRTD的患者（178例男性，平均年龄66±10岁，31 - 89岁）。分析了以下数据：年龄、性别、扩张型心肌病的存在、糖尿病、肌酐清除率降低、心房颤动（AF）、左心室射血分数（LVEF）、纽约心脏协会（NYHA）分级、充分干预、心律失常数量、药物治疗调整、设备参数和死亡率。
左心室平均射血分数为20.9±6.4，（10.0 - 35%）。在平均770±490天的随访期间，84例（37%）患者发生了设备的充分干预。充分干预主要涉及糖尿病患者（风险比[HR] 2.95）、NYHA II级、阵发性心房颤动患者（HR 2.15）。39例患者（17%）的双心室起搏平均百分比低于90%，18例（8%）低于85%。
糖尿病、NYHA II级、阵发性心房颤动显著增加了充分干预的风险。双心室起搏丧失的最常见原因是：房室延迟不当、室上性心律失常和室性早搏。观察到双心室起搏低百分比与室上性心律失常的发生和充分干预之间存在显著相关性。
