First Department of Medicine, Faculty of Medicine Mannheim, European Center for AngioScience (ECAS), and DZHK, University Medical Centre Mannheim (UMM), University of Heidelberg, German Center for Cardiovascular Research) partner site Heidelberg/Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
Department of Cardiology and Angiology II, University Heart Center Freiburg Bad Krozingen, Bad Krozingen, Germany.
Clin Res Cardiol. 2019 Aug;108(8):878-891. doi: 10.1007/s00392-019-01416-y. Epub 2019 Feb 12.
The study sought to evaluate the prognostic impact of recurrences of ventricular tachyarrhythmias in consecutive ICD recipients with ventricular tachyarrhythmias on admission.
All consecutive patients surviving at least one episode of ventricular tachyarrhythmias from 2002 to 2016 and discharged with an ICD (pre-existing ICD or ICD implantation at index hospitalization) were included. The primary endpoint was all-cause mortality according to the presence or absence of recurrences of ventricular tachyarrhythmias at 5 years. Secondary endpoints comprised the impact of different types of recurrences, appropriate ICD therapies, as well as predictors of recurrences and appropriate ICD therapies. Kaplan-Meier, multivariable Cox regression and propensity score matching analyses were applied.
A total of 592 consecutive ICD recipients was included (44% with recurrences of ventricular tachyarrhythmias and 56% without). Recurrences of ventricular tachyarrhythmias were associated with increased all-cause mortality at 5 years (HR = 1.498; 95% CI = 1.052-2.132; p = 0.025). Worst survival was observed in patients with sustained VT or VF as first recurrences compared to non-sustained VT, as well as in patients with cumulative recurrences of non-sustained or sustained VT plus VF, whereas mortality was not affected by the number of recurrences of ventricular tachyarrhythmias (> 4 vs. ≤ 4). Moreover, appropriate ICD therapies were associated with increased all-cause mortality (HR = 1.874; 95% CI = 1.318-2.666; p = 0.001), mainly attributed to secondary preventive ICDs. Finally, atrial fibrillation, LVEF < 35% and non-ischemic cardiomyopathy were identified as predictors of recurrences of ventricular tachyarrhythmias and appropriate ICD therapies.
Recurrences of ventricular tachyarrhythmias and recurrent appropriate ICD therapies are associated with increased long-term all-cause mortality in consecutive ICD recipients. Non-ischemic cardiomyopathy, AF and LVEF < 35% revealed to be significant predictors of both endpoints.
本研究旨在评估连续因室性心动过速而接受 ICD 治疗的患者入院时出现的室性心动过速复发对预后的影响。
纳入 2002 年至 2016 年期间至少经历过一次室性心动过速发作并存活下来且出院时携带 ICD（既往 ICD 或住院期间植入 ICD）的所有连续患者。主要终点为根据 5 年时是否发生室性心动过速复发评估全因死亡率。次要终点包括不同类型复发、合适 ICD 治疗的影响，以及复发和合适 ICD 治疗的预测因素。采用 Kaplan-Meier、多变量 Cox 回归和倾向评分匹配分析。
共纳入 592 例连续 ICD 患者（44%有室性心动过速复发，56%无）。室性心动过速复发与 5 年时全因死亡率增加相关（HR=1.498；95%CI=1.052-2.132；p=0.025）。与非持续性 VT 相比，首次复发为持续性 VT 或 VF 的患者生存最差，与非持续性 VT 加持续性 VT 加 VF 累积复发的患者相比，死亡率不受室性心动过速复发次数（＞4 次 vs. ≤4 次）的影响。此外，合适的 ICD 治疗与全因死亡率增加相关（HR=1.874；95%CI=1.318-2.666；p=0.001），这主要归因于二级预防 ICD。最后，心房颤动、LVEF＜35%和非缺血性心肌病被确定为室性心动过速复发和合适 ICD 治疗的预测因素。
连续 ICD 患者的室性心动过速复发和复发的合适 ICD 治疗与长期全因死亡率增加相关。非缺血性心肌病、AF 和 LVEF＜35%是这两个终点的重要预测因素。
