Department of Public Health and Clinical Medicine, Heart Centre, Umeå University, Umeå, Sweden.
Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden.
Scand Cardiovasc J. 2021 Feb;55(1):22-28. doi: 10.1080/14017431.2020.1792973. Epub 2020 Jul 16.
Implantable cardiac devices are common in patients with tetralogy of Fallot (ToF) (18.3-21.3%) according to previous reports from large centres. We conducted this study to investigate the prevalence and incidence of cardiac devices in a less selected population of patients with ToF and assess factors other than arrhythmia associated with having a device. 530 adult (≥18 years) patients with repaired ToF were identified in the national registry of congenital heart disease (SWEDCON) and matched with data from the Swedish pacemaker registry. Patients with implantable cardiac devices were compared with patients without devices. : Seventy-five patients (14.2%) had a device; 51 (9.6%) had a pacemaker and 24 (4.5%) had an implantable cardioverter defibrillator. The incidence in adult age (≥18 years) was 5.9/1000 patient years. Estimated device free survival was 97.5% at twenty, 87.2% at forty and 63.5% at sixty years of age. Compared with previous studies, the prevalence of devices was lower, especially for ICD. In multivariate logistic regression, cardiovascular medication (odds ratio [OR] 3.5, 95% confidence interval [CI] 1.8-6.8), impaired left ventricular function, (OR 2.6, 95%CI 1.3-5.0) and age (OR 1.02, 95%CI 1.002-1.05) were associated with having a device. : The prevalence of devices in our population, representing a multicenter register cohort, was lower than previously reported, especially regarding ICD. This can be due to differences in treatment traditions with regard to ICD in this population, but it may also be that previous studies have reported selected patients with more severe disease.
据以往大型中心的报告，在法洛四联症（ToF）患者中，植入式心脏装置很常见（18.3-21.3%）。我们进行这项研究是为了调查在一个选择较少的 ToF 患者人群中，心脏装置的流行率和发病率，并评估除心律失常以外与使用装置相关的其他因素。在全国先天性心脏病登记处（SWEDCON）中确定了 530 名成年（≥18 岁）修复后的 ToF 患者，并与瑞典起搏器登记处的数据相匹配。将有植入式心脏装置的患者与无装置的患者进行比较。75 名患者（14.2%）有装置；51 名（9.6%）有起搏器，24 名（4.5%）有植入式心脏除颤器。成年（≥18 岁）的发病率为 5.9/1000 患者年。估计无装置生存时间在 20 年时为 97.5%，在 40 年时为 87.2%，在 60 年时为 63.5%。与以往的研究相比，装置的患病率较低，特别是 ICD。在多变量逻辑回归中，心血管药物（比值比[OR]3.5，95%置信区间[CI]1.8-6.8）、左心室功能受损（OR2.6，95%CI1.3-5.0）和年龄（OR1.02，95%CI1.002-1.05）与使用装置有关。在我们的人群中，代表多中心登记队列的装置流行率低于以前的报告，特别是关于 ICD。这可能是由于该人群 ICD 治疗传统的差异，但也可能是以前的研究报告了病情更严重的选择性患者。
