与室性心动过速相比，电风暴与预后不良有关。

Electrical storm is associated with impaired prognosis compared to ventricular tachyarrhythmias.

机构信息

First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) partner site Heidelberg/Mannheim, Mannheim, Germany.

出版信息

Int J Cardiol. 2019 Oct 1;292:119-125. doi: 10.1016/j.ijcard.2019.04.034. Epub 2019 Apr 12.

DOI:10.1016/j.ijcard.2019.04.034

PMID:31076250

Abstract

BACKGROUND

Because data on electrical storm (ES) is limited, this study sought to compare the prognosis of patients with ES to those with ventricular tachyarrhythmias on mortality, rehospitalization and major adverse cardiac events (MACE).

METHODS

In this retrospective study consecutive implantable cardioverter defibrillator (ICD) recipients presenting with ES were compared to patients surviving ventricular tachyarrhythmias (ventricular tachycardia (VT) or fibrillation (VF); non-ES) on admission from 2002 to 2016. The primary endpoint was all-cause mortality, secondary endpoints were rehospitalization and MACE at 2.5 years of follow-up.

RESULTS

764 consecutive patients with an ICD were included (11% with ES, 89% with VTA). ES was associated with higher rates of all-cause mortality (37% vs. 20%, log-rank p = 0.001; HR 2.084; 95% CI 1.416-3.065, p = 0.001). However, only in secondary preventive ICD recipients, ES remained significantly associated with mortality (39% vs. 20%; log rank p = 0.001; HR 2.235, 95% CI 1.378-3.625, p = 0.001). Furthermore, ES was associated with higher rates of rehospitalization (44% vs. 12%, log-rank p = 0.001; HR 4.763, 95% CI 3.237-7.009, p = 0.001), mainly due to VT (22% vs. 4%, p = 0.001) and acute heart failure (AHF) (17% vs. 4%, p = 0.001) and higher rates of MACE (40% vs. 23%; log rank p = 0.001; HR 1.838; 95% CI 1.273-2.654, p = 0.002). Increasing risks of death and rehospitalization were still observed even after multivariable adjustment.

CONCLUSION

ES was associated with increased rates of all-cause mortality, rehospitalization, respectively due to VT and AHF, as well as MACE at 2.5 years compared to patients with ventricular tachyarrhythmias apart from ES.

摘要

背景

由于关于电风暴（ES）的数据有限，本研究旨在比较 ES 患者与因室性心动过速心律失常（室性心动过速（VT）或颤动（VF）；非 ES）入院的患者的死亡率、再住院率和主要不良心脏事件（MACE）的预后。

方法

在这项回顾性研究中，比较了 2002 年至 2016 年期间连续植入式心脏复律除颤器（ICD）患者的 ES 患者与存活的室性心动过速心律失常（VT 或 VF；非 ES）患者的预后。主要终点是全因死亡率，次要终点是 2.5 年随访时的再住院率和 MACE。

结果

共纳入 764 例连续 ICD 患者（11%为 ES，89%为 VTA）。ES 与全因死亡率升高相关（37% vs. 20%，log-rank p=0.001；HR 2.084；95% CI 1.416-3.065，p=0.001）。然而，只有在二级预防 ICD 接受者中，ES 与死亡率仍显著相关（39% vs. 20%；log rank p=0.001；HR 2.235，95% CI 1.378-3.625，p=0.001）。此外，ES 与再住院率升高相关（44% vs. 12%，log-rank p=0.001；HR 4.763，95% CI 3.237-7.009，p=0.001），主要是由于 VT（22% vs. 4%，p=0.001）和急性心力衰竭（AHF）（17% vs. 4%，p=0.001），并且 MACE 发生率更高（40% vs. 23%；log rank p=0.001；HR 1.838；95% CI 1.273-2.654，p=0.002）。即使在多变量调整后，死亡和再住院的风险仍在增加。