肥厚型心肌病患者皮下植入式心律转复除颤器中的适当和不适当电击：一项国际多中心研究。
Appropriate and inappropriate shocks in hypertrophic cardiomyopathy patients with subcutaneous implantable cardioverter-defibrillators: An international multicenter study.
机构信息
Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon.
Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon.
出版信息
Heart Rhythm. 2020 Jul;17(7):1107-1114. doi: 10.1016/j.hrthm.2020.02.008. Epub 2020 Feb 18.
BACKGROUND
Subcutaneous implantable cardioverter-defibrillators (S-ICDs) are attractive for preventing sudden cardiac death in hypertrophic cardiomyopathy (HCM) as they mitigate risks of transvenous leads in young patients. However, S-ICDs may be associated with increased inappropriate shock (IAS) in HCM patients.
OBJECTIVE
The purpose of this study was to assess the incidence and predictors of appropriate shock and IAS in a contemporary HCM S-ICD cohort.
METHODS
We collected electrocardiographic and clinical data from HCM patients who underwent S-ICD implantation at 4 centers. Etiologies of all S-ICD shocks were adjudicated. We used Firth penalized logistic regression to derive adjusted odds ratios (aORs) for predictors of IAS.
RESULTS
Eighty-eight HCM patients received S-ICDs (81 for primary and 7 for secondary prevention) with a mean follow-up of 2.7 years. Five patients (5.7%) had 9 IAS episodes (3.8 IAS per 100 patient-years) most often because of sinus tachycardia and/or T-wave oversensing. Independent predictors of IAS were higher 12-lead electrocardiographic R-wave amplitude (aOR 2.55 per 1 mV; 95% confidence interval 1.15-6.38) and abnormal T-wave inversions (aOR 0.16; 95% confidence interval 0.02-0.97). There were 2 appropriate shocks in 7 secondary prevention patients and none in 81 primary prevention patients, despite 96% meeting Enhanced American College of Cardiology/American Heart Association criteria and the mean European HCM Risk-SCD score predicting 5.7% 5-year risk. No patients had sudden death or untreated sustained ventricular arrhythmias.
CONCLUSION
In this multicenter HCM S-ICD study, IAS were rare and appropriate shocks confined to secondary prevention patients. The R-wave amplitude increased IAS risk, whereas T-wave inversions were protective. HCM primary prevention implantable cardioverter-defibrillator guidelines overestimated the risk of appropriate shocks in our cohort.
背景
皮下植入式心律转复除颤器（S-ICD）在肥厚型心肌病（HCM）中预防心源性猝死具有吸引力，因为它降低了年轻患者经静脉导联的风险。然而，S-ICD 可能与 HCM 患者的不适当电击（IAS）增加有关。
目的
本研究旨在评估当代 HCM S-ICD 队列中适当电击和 IAS 的发生率和预测因素。
方法
我们从在 4 个中心接受 S-ICD 植入的 HCM 患者中收集心电图和临床数据。所有 S-ICD 电击的病因均经裁决。我们使用 Firth 惩罚逻辑回归得出 IAS 预测因素的调整优势比（aOR）。
结果
88 例 HCM 患者接受了 S-ICD（81 例为原发性，7 例为二级预防），平均随访 2.7 年。5 例患者（5.7%）发生了 9 次 IAS 发作（每 100 患者年 3.8 次 IAS），最常见的原因是窦性心动过速和/或 T 波过感知。IAS 的独立预测因素是较高的 12 导联心电图 R 波振幅（aOR 每 1 mV 2.55；95%置信区间 1.15-6.38）和异常 T 波倒置（aOR 0.16；95%置信区间 0.02-0.97）。7 例二级预防患者中有 2 例发生适当电击，81 例一级预防患者中无一例发生适当电击，尽管 96%符合增强的美国心脏病学会/美国心脏协会标准，且平均欧洲 HCM 风险-SCD 评分预测 5 年风险为 5.7%。没有患者发生猝死或未经治疗的持续性室性心律失常。
结论
在这项多中心 HCM S-ICD 研究中，IAS 很少见，适当电击仅限于二级预防患者。R 波振幅增加了 IAS 的风险，而 T 波倒置则具有保护作用。我们队列中的 HCM 一级预防植入式心律转复除颤器指南高估了适当电击的风险。
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