不适当的植入式心脏复律除颤器电击的决定因素：德国器械注册研究的观点
Determinants of inappropriate implantable cardioverter-defibrillator shocks: the German Device Registry perspective.
作者信息
Safak Erdal, Eckardt Lars, Jung Werner, Ince Hüseyin, Senges Jochen, Hochadel Matthias, Perings Christian, Spitzer Stefan, Brachmann Johannes, Seidl Karlheinz, Hink Hans Ulrich, D'Ancona Giuseppe
机构信息
Vivantes Klinikum Am Urban, Diffenbach strasse, Berlin, Germany.
Rostock University Medical Center, Rostock, Germany.
出版信息
J Interv Card Electrophysiol. 2019 Oct;56(1):71-77. doi: 10.1007/s10840-019-00600-4. Epub 2019 Aug 2.
BACKGROUND
In the present study, we have focused upon rates and clinical determinants of inappropriate shock (IS) after implantable cardioverter-defibrillator (ICD).
METHODS
Data were collected prospectively in the German Device II Registry.
RESULTS
A total of 783 patients were included. Three sub-groups were identified: non-shock (NS) included 725 patients (92.6%), IS 24 (3.1%), and appropriate shock (AS) 34 (4.3%). IS patients were younger (AS 68 (58-77); IS 59 (51-68); NS 66 (56-75) years; p = 0.03), had been mainly referred for primary prophylaxis (AS 42.4%; IS 70.8%; NS 67.3%; p = 0.01), had a higher resting heart rate (AS 70 (63-80); IS 80 (71-98); NS 70 (60-81) BPM; p = 0.003), had more often atrial fibrillation (AF) (AS 14.7%; IS 45.8%; NS 18.8%; p = 0.006), and shorter QRS duration (AS 100 (90-120); IS 95 (90-100); NS 120 (98-150) msec.; p = 0.001). VVI-ICD was more common in IS (AS 64.7%; IS 83.3%; NS 49.8%; p = 0.002). At a follow-up of 18.2 months (75% IQR 13.6-22.4), no deaths were observed in the IS group, one (2.9%) in the AS, and 36 (4.9%) in the NS (p = 0.9). At logistic regression, VVI-ICD implantation was the strongest IS independent determinant (OR 5.0; 95% CI 1.6-15.9; p = 0.004) together with age < 70 years (OR 4.6; CI 1.4-14.7; p = 0.009), AF at time of ICD implantation (OR 3.5; CI 1.3-9.1; p = 0.01), and resting heart rate > 70/min (OR 2.8; CI 1.0-7.3; p = 0.03).
CONCLUSION
In a contemporary setting, some specific conditions such as VVI-ICD, younger age, and faster resting heart rates remain important IS determinants after ICD implantation.
背景
在本研究中，我们重点关注植入式心脏复律除颤器（ICD）术后不适当电击（IS）的发生率及临床决定因素。
方法
前瞻性收集德国器械II注册研究中的数据。
结果
共纳入783例患者。确定了三个亚组：非电击（NS）组725例患者（92.6%），IS组24例（3.1%），适当电击（AS）组34例（4.3%）。IS组患者更年轻（AS组68岁（58 - 77岁）；IS组59岁（51 - 68岁）；NS组66岁（56 - 75岁）；p = 0.03），主要因一级预防转诊（AS组42.4%；IS组70.8%；NS组67.3%；p = 0.01），静息心率更高（AS组70次/分（63 - 80次/分）；IS组80次/分（71 - 98次/分）；NS组70次/分（60 - 81次/分）；p = 0.003），房颤（AF）更常见（AS组14.7%；IS组45.8%；NS组18.8%；p = 0.006），QRS时限更短（AS组100毫秒（90 - 120毫秒）；IS组95毫秒（90 - 100毫秒）；NS组120毫秒（98 - 150毫秒）；p = 0.001）。VVI - ICD在IS组更常见（AS组64.7%；IS组83.3%；NS组49.8%；p = 0.002）。在18.2个月的随访期（四分位间距75%为13.6 - 22.4个月），IS组未观察到死亡，AS组1例（2.9%），NS组36例（4.9%）（p = 0.9）。在逻辑回归分析中，VVI - ICD植入是最强的IS独立决定因素（比值比5.0；95%置信区间1.6 - 15.9；p = 0.004），同时还有年龄<70岁（比值比4.6；置信区间1.4 - 14.7；p = 0.009）、ICD植入时房颤（比值比3.5；置信区间1.3 - 9.1；p = 0.01）以及静息心率>70次/分（比值比2.8；置信区间1.0 - 7.3；p = 0.03）。
结论
在当代环境下，一些特定情况，如VVI - ICD、年轻以及静息心率较快，仍是ICD植入术后IS的重要决定因素。
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