Jagielski Dariusz, Zyśko Dorota, Nadolny Klaudiusz, Wizowska Joanna, Biel Bartosz, Banasiak Waldemar, Ponikowski Piotr
Department of Cardiology, Centre for Heart Diseases, 4th Military Hospital, Wroclaw, Poland.
Department and Clinic Of Emergency Medicine, Wroclaw Medical University, Wroclaw, Poland.
Wiad Lek. 2019;72(7):1243-1246.
Introduction: Inappropriate shocks in patients with an implantable cardioverter-defibrillator (ICD) are associated with significant psychological and physical consequences and increased long-term mortality. The aim: To assess predictors associated with inappropriate high-energy discharges of implantable cardioverter-defibrillators.
Material and Methods: Retrospective data analysis of 150 patients aged 64.2±12.8 years (84.7% male) admitted to the Hospital Emergency Department due to at least one cardioverter-defibrillator discharge was performed. All of the discharges were inappropriate in the group of 33 patients, and in the group of 117 patients at least one discharge was appropriate. The following data: age, gender, concomitant diseases, type of ICD implantation (primary vs. secondary prevention), type of discharge, number of discharges, serum potassium, and sodium concentration were collected.
Results: Patients with only inappropriate discharges were younger, significantly more often had chronic atrial fibrillation, a significantly higher number of discharges, and ischaemic cardiomyopathy. Logistic regression analysis revealed that the occurrence of only inappropriate discharges was related to the number of discharges over three, the age of patients below 60 years, the serum sodium concentration between 135 mEq/L and 142 mEq/L, and the primary type of prevention of sudden cardiac death.
Conclusions: 1. Predictors of inappropriate discharges include: age, serum sodium concentration, and primary type of indications for cardioverter-defibrillator implantation. 2. Further research is necessary to determine the influence of disturbances in the sodium economy on the occurrence of appropriate and inappropriate interventions of implantable cardioverter-defibrillators.
引言：植入式心脏复律除颤器（ICD）患者发生不适当电击会带来严重的心理和生理后果，并增加长期死亡率。目的：评估与植入式心脏复律除颤器不适当高能量放电相关的预测因素。
材料与方法：对150例因至少一次心脏复律除颤器放电而入住医院急诊科的患者进行回顾性数据分析，患者年龄64.2±12.8岁（男性占84.7%）。33例患者的所有放电均不适当，117例患者中至少有一次放电是适当的。收集了以下数据：年龄、性别、伴随疾病、ICD植入类型（一级预防与二级预防）、放电类型、放电次数、血清钾和钠浓度。
结果：仅发生不适当放电的患者更年轻，慢性房颤的发生率显著更高，放电次数显著更多，且患有缺血性心肌病。逻辑回归分析显示，仅发生不适当放电与三次以上放电次数、60岁以下患者年龄、135 mEq/L至142 mEq/L之间的血清钠浓度以及心脏性猝死的一级预防类型有关。
结论：1. 不适当放电的预测因素包括：年龄、血清钠浓度以及心脏复律除颤器植入的主要指征类型。2. 需要进一步研究以确定钠代谢紊乱对植入式心脏复律除颤器适当和不适当干预发生的影响。
