MacIntyre Ciorsti J, Sapp John L, Abdelwahab Amir, Al-Harbi Mousa, Doucette Steve, Gray Chris, Gardner Martin J, Parkash Ratika
Department of Medicine, Division of Cardiology, QEII Health Sciences Centre, Halifax, Nova Scotia, Canada.
Research Methods Unit, Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada.
CJC Open. 2019 Jun 7;1(4):161-167. doi: 10.1016/j.cjco.2019.04.003. eCollection 2019 Jul.
Prior studies have demonstrated an association between appropriate implantable cardioverter defibrillator (ICD) shocks and mortality in clinical trials. The effect of shock burden on heart failure and mortality has not been previously studied in a large population-based cohort.
The cohort was derived using a comprehensive prospective ICD registry in the province of Nova Scotia with a mean follow-up of 4 ± 2.3 years. With the use of time-varying analysis, the relationship among shock burden, mortality, and heart failure hospitalization was determined.
A total of 776 patients (mean age of 64.8 years) were included in the study, of whom 37% received appropriate therapy during follow-up. A single ICD shock did not confer an increased mortality risk compared with no therapy (hazard ratio [HR], 1.23; 95% confidence interval [CI], 0.84-1.79; 0.3), but mortality risk was significantly increased with ≥ 2 shocks (HR, 3.23; 95% CI, 2.04-5.09; 0.0001). There was a significant increase in heart failure hospitalization associated with receiving 1 ICD shock (HR, 2.05; 95% CI, 1.46-2.89; 0.0001) or more than 1 ICD shock (HR, 4.36; CI, 2.53-7.52; 0.0001) compared with patients receiving no ICD therapy. Patients who received antitachycardia pacing alone showed no difference in heart failure hospitalization (HR, 0.93; CI, 0.67-1.29; 0.7) and improved survival (HR, 0.69; CI, 0.5-0.96; 0.03) compared with those receiving no ICD therapy.
Ventricular arrhythmia treated with appropriate ICD shocks is associated with an increased risk of heart failure hospitalization, whereas recurrent episodes of ventricular arrhythmia requiring shocks are associated with both higher mortality and higher heart failure hospitalization rates.
先前的研究已在临床试验中证实了适当的植入式心脏复律除颤器（ICD）电击与死亡率之间的关联。电击负担对心力衰竭和死亡率的影响此前尚未在大型人群队列中进行研究。
该队列来自新斯科舍省一个全面的前瞻性ICD登记处，平均随访时间为4±2.3年。通过使用时变分析，确定了电击负担、死亡率和心力衰竭住院之间的关系。
共有776名患者（平均年龄64.8岁）纳入研究，其中37%在随访期间接受了适当的治疗。与未接受治疗相比，单次ICD电击并未增加死亡风险（风险比[HR]，1.23；95%置信区间[CI]，0.84 - 1.79；P = 0.3），但≥2次电击时死亡风险显著增加（HR，3.23；95% CI，2.04 - 5.09；P = 0.0001）。与未接受ICD治疗的患者相比，接受1次ICD电击（HR，2.05；95% CI，1.46 - 2.89；P = 0.0001）或超过1次ICD电击（HR，4.36；CI，2.53 - 7.52；P = 0.0001）与心力衰竭住院显著增加相关。仅接受抗心动过速起搏的患者与未接受ICD治疗的患者相比，心力衰竭住院无差异（HR，0.93；CI，0.67 - 1.29；P = 0.7）且生存率提高（HR，0.69；CI，0.5 - 0.96；P = 0.03）。
用适当的ICD电击治疗室性心律失常与心力衰竭住院风险增加相关，而需要电击的室性心律失常复发与更高的死亡率和更高的心力衰竭住院率相关。
