Klinikum Ludwigshafen, Medizinische Klinik B, Bremserstraße 79, 67063, Ludwigshafen, Germany.
Clin Res Cardiol. 2020 Jan;109(1):89-95. doi: 10.1007/s00392-019-01491-1. Epub 2019 May 13.
The prognostic relevance of new onset arrhythmias compared to ICD shocks in ICD patients is not well known.
Aim of the study was to evaluate the prognostic relevance of new onset atrial fibrillation (AF) or ventricular arrhythmias (VT/VF) compared to ICD shocks in primary prophylactic ICD-patients.
A total of 622 of 1955 (32%) patients of the prospective single-centre ICD-registry Ludwigshafen with primary prophylactic ICD indication and sinus rhythm (SR) at baseline without history of AF were analyzed. All patients underwent an ICD implantation between 1992 and 2012.
During the median follow-up time of 6 years, 200 (32%) ICD patients developed new AF and 249 (40%) patients new VT/VF. There was an approximately 10% increase of 5-year mortality rate depending on the type of new onset arrhythmia (no arrhythmia 19%, new AF 28%, new VT 36% and new VF 55% 5-year mortality). In a multivariate analysis, new onset of AF or VT/VF was an independent predictor for increased mortality whereas VT shocks and inappropriate ICD shocks were not.
More than half of primary prophylactic ICD patients with SR at baseline develop new AF or VT/VF after 6 years. New onset arrhythmias of AF and VT/VF are independent prognostic factors for increased mortality in primary prophylactic ICD patients. ICD shocks itself, inappropriate or appropriate, are not additionally associated with a worse outcome. These results support the hypothesis that in clinical practice rather the arrhythmia than the ICD shock itself is responsible for a deteriorated prognosis.
与 ICD 电击相比，新发心律失常在 ICD 患者中的预后相关性尚不清楚。
本研究旨在评估与 ICD 电击相比，新发心房颤动（AF）或室性心律失常（VT/VF）在原发性预防 ICD 患者中的预后相关性。
对前瞻性、单中心 ICD 注册中心 Ludwigshafen 中 1955 例（32%）具有原发性预防 ICD 适应证且基线时窦性节律（SR）且无 AF 病史的患者进行了分析。所有患者均于 1992 年至 2012 年间接受 ICD 植入。
在中位随访 6 年期间，200 例（32%）ICD 患者新发 AF，249 例（40%）患者新发 VT/VF。新发心律失常的 5 年死亡率约增加 10%（无心律失常 19%、新发 AF 28%、新发 VT 36%和新发 VF 55%）。多变量分析显示，新发 AF 或 VT/VF 是死亡率增加的独立预测因素，而 VT 电击和不适当的 ICD 电击则不是。
超过一半的基线时 SR 的原发性预防 ICD 患者在 6 年后会新发 AF 或 VT/VF。新发 AF 和 VT/VF 是原发性预防 ICD 患者死亡率增加的独立预后因素。ICD 电击本身（适当或不适当）与较差的结局无额外关联。这些结果支持以下假说，即在临床实践中，导致预后恶化的可能是心律失常而不是 ICD 电击本身。
