Division of Cardiology, Hartford Hospital, University of Connecticut, Hartford, Connecticut.
Division of Cardiology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
Heart Rhythm. 2021 Jan;18(1):63-70. doi: 10.1016/j.hrthm.2020.08.009. Epub 2020 Aug 12.
Identifying patients with hypertrophic cardiomyopathy (HCM) who warrant a primary prevention implantable cardioverter-defibrillator (ICD) is crucial. ICDs are effective in terminating life-threatening arrhythmias; however, ICDs carry risks of complications.
The purpose of this study was to assess the incidence and predictors of appropriate ICD therapies, inappropriate shocks, and device-related complications in patients with HCM and primary prevention ICDs.
All patients with HCM who underwent primary prevention ICD implantation at Toronto General Hospital between September 2000 and December 2017 were identified. Therapies (shocks or antitachycardia pacing) for ventricular tachycardia >180 beats/min or ventricular fibrillation were considered appropriate.
Three hundred two patients were followed for a mean 6.1 ± 4.3 years (1801 patient-years of follow-up). Thirty-eight patients (12.6%) received at least 1 appropriate ICD therapy (2.3%/y); the 5-year cumulative probability of receiving appropriate ICD therapy was 9.6%. None of the conventional risk factors nor the European Society of Cardiology risk score was associated with appropriate ICD therapy. In multivariable analysis, age < 40 years at implantation and atrial fibrillation were independent predictors of appropriate ICD therapy. In a subgroup of patients who had undergone cardiac magnetic resonance imaging before ICD implantation, severe late gadolinium enhancement was the strongest predictor of appropriate ICD therapies. ICD-related complications or inappropriate shocks occurred in 87 patients (28.8%), with an inappropriate shock rate of 2.1%/y; the 5-year cumulative probability was 10.7%.
The incidence of appropriate ICD therapies in patients with HCM and primary prevention ICDs is lower than previously reported; a high proportion of patients suffer from an ICD-related complication. Traditional risk factors have low predictive utility. Severe late gadolinium enhancement, atrial fibrillation, and young age are important predictors of ventricular tachyarrhythmias in HCM.
识别需要植入式心脏复律除颤器（ICD）进行一级预防的肥厚型心肌病（HCM）患者至关重要。ICD 可有效终止威胁生命的心律失常；然而，ICD 也存在并发症风险。
本研究旨在评估 HCM 伴一级预防 ICD 患者中 ICD 治疗的适当性、不适当电击和与器械相关的并发症的发生率和预测因素。
确定 2000 年 9 月至 2017 年 12 月在多伦多总医院接受一级预防 ICD 植入的所有 HCM 患者。对于 >180 次/分的室性心动过速或心室颤动，给予电击或抗心动过速起搏治疗被认为是适当的。
302 例患者的平均随访时间为 6.1±4.3 年（1801 患者-年）。38 例（12.6%）患者至少接受了 1 次适当的 ICD 治疗（2.3%/年）；5 年累积接受适当 ICD 治疗的概率为 9.6%。传统危险因素和欧洲心脏病学会风险评分均与适当的 ICD 治疗无关。多变量分析显示，植入时年龄<40 岁和心房颤动是适当 ICD 治疗的独立预测因素。在植入 ICD 前接受心脏磁共振成像检查的患者亚组中，严重的晚期钆增强是适当 ICD 治疗的最强预测因素。87 例（28.8%）患者发生 ICD 相关并发症或不适当电击，不适当电击率为 2.1%/年；5 年累积概率为 10.7%。
HCM 伴一级预防 ICD 患者的适当 ICD 治疗发生率低于既往报道；很大一部分患者出现 ICD 相关并发症。传统危险因素的预测能力较低。严重的晚期钆增强、心房颤动和年轻是 HCM 中室性心动过速的重要预测因素。
