Electrophysiology Unit, Department of Cardiology, Fondazione Cardiocentro Ticino, via Tesserete 48, Lugano, Switzerland.
Department of Cardiology, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Europace. 2019 Nov 1;21(11):1670-1677. doi: 10.1093/europace/euz221.
To define the clinical characteristics and long-term clinical outcomes of a large cohort of patients with idiopathic ventricular fibrillation (IVF) and normal 12-lead electrocardiograms (ECGs).
Patients with ventricular fibrillation as the presenting rhythm, normal baseline, and follow-up ECGs with no signs of cardiac channelopathy including early repolarization or atrioventricular conduction abnormalities, and without structural heart disease were included in a registry. A total of 245 patients (median age: 38 years; males 59%) were recruited from 25 centres. An implantable cardioverter-defibrillator (ICD) was implanted in 226 patients (92%), while 18 patients (8%) were treated with drug therapy only. Over a median follow-up of 63 months (interquartile range: 25-110 months), 12 patients died (5%); in four of them (1.6%) the lethal event was of cardiac origin. Patients treated with antiarrhythmic drugs only had a higher rate of cardiovascular death compared to patients who received an ICD (16% vs. 0.4%, P = 0.001). Fifty-two patients (21%) experienced an arrhythmic recurrence. Age ≤16 years at the time of the first ventricular arrhythmia was the only predictor of arrhythmic recurrence on multivariable analysis [hazard ratio (HR) 0.41, 95% confidence interval (CI) 0.18-0.92; P = 0.03].
Patients with IVF and persistently normal ECGs frequently have arrhythmic recurrences, but a good prognosis when treated with an ICD. Children are a category of IVF patients at higher risk of arrhythmic recurrences.
定义特发性室颤(IVF)和正常 12 导联心电图(ECG)患者的大样本临床特征和长期临床结局。
本研究纳入了心室颤动作为首发节律、基线正常且随访 ECG 无心脏通道病迹象(包括早期复极或房室传导异常)且无结构性心脏病的患者。共从 25 个中心招募了 245 名患者(中位年龄:38 岁;男性占 59%)。226 名患者(92%)植入了植入式心律转复除颤器(ICD),18 名患者(8%)仅接受药物治疗。中位随访 63 个月(四分位距:25-110 个月)期间,12 名患者死亡(5%);其中 4 例(1.6%)的致死事件为心源性。仅接受抗心律失常药物治疗的患者心血管死亡率高于接受 ICD 治疗的患者(16% vs. 0.4%,P=0.001)。52 名患者(21%)经历了心律失常复发。首次室性心律失常时年龄≤16 岁是多变量分析中心律失常复发的唯一预测因素[风险比(HR)0.41,95%置信区间(CI)0.18-0.92;P=0.03]。
持续性正常 ECG 的 IVF 患者常发生心律失常复发,但 ICD 治疗预后良好。儿童是心律失常复发风险较高的 IVF 患者类别。