Schupp Tobias, Behnes Michael, Kim Seung-Hyun, Müller Julian, Weidner Kathrin, Reiser Linda, Huseynov Aydin, Bollow Armin, Borggrefe Martin, Taton Gabriel, Reichelt Thomas, Ellguth Dominik, Engelke Niko, Akin Muharrem, Große Meininghaus Dirk, Bertsch Thomas, Akin Ibrahim
First Department of Medicine, Faculty of Medicine Mannheim, University Medical Centre Mannheim (UMM), University of Heidelberg, DZHK (German Center for Cardiovascular Research) Partner Site Heidelberg/Mannheim, Mannheim, Germany.
Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany.
Basic Clin Pharmacol Toxicol. 2021 Mar;128(3):493-502. doi: 10.1111/bcpt.13532. Epub 2020 Nov 27.
This study sought to assess the prognostic impact of treatment with single beta-blocker (BB) compared to combined therapy with BB plus amiodarone (BB-AMIO) on recurrences of ventricular tachyarrhythmias in implantable cardioverter-defibrillator (ICD) recipients. A large retrospective registry was used including consecutive ICD recipients with index episodes of ventricular tachyarrhythmias from 2002 to 2016. Patients treated with BB were compared to patients treated with BB-AMIO. Kaplan-Meier and Cox regression analyses were applied for the evaluation of the primary end-point defined as first recurrences of ventricular tachyarrhythmias at five years. Secondary end-points comprised first appropriate ICD therapies, first cardiac rehospitalization and all-cause mortality at five years. Among 512 ICD recipients, 81% were treated with BB and 19% with BB-AMIO. BB and BB-AMIO were associated with comparable risk of first recurrences of ventricular tachyarrhythmias (46% vs. 43%; log rank P = .941; HR = 1.013; 95% CI 0.725-1.415; P = .941) and appropriate ICD therapies (35% vs. 37%; log rank P = .389; HR = 0.852; 95% CI 0.591-1.228; P = .390). BB was associated with decreased long-term all-cause mortality within an univariable analysis only (20% vs. 28%; log rank p = 0.023). In conclusion, BB and BB-AMIO were associated with comparable risks regarding recurrences of ventricular tachyarrhythmias at five years.
本研究旨在评估与β受体阻滞剂(BB)联合胺碘酮(BB-AMIO)的联合治疗相比,单用BB治疗对植入式心脏复律除颤器(ICD)植入者室性快速心律失常复发的预后影响。研究使用了一个大型回顾性登记数据库,纳入了2002年至2016年期间因室性快速心律失常首次发作而连续接受ICD治疗的患者。将接受BB治疗的患者与接受BB-AMIO治疗的患者进行比较。应用Kaplan-Meier法和Cox回归分析来评估定义为5年时室性快速心律失常首次复发的主要终点。次要终点包括首次适当的ICD治疗、首次心脏再住院以及5年时的全因死亡率。在512例ICD植入者中,81%接受了BB治疗,19%接受了BB-AMIO治疗。BB和BB-AMIO与室性快速心律失常首次复发的风险相当(46%对43%;对数秩检验P = 0.941;风险比[HR]=1.013;95%置信区间[CI]0.725-1.415;P = 0.941),且与适当的ICD治疗相当(35%对37%;对数秩检验P = 0.389;HR = 0.852;95%CI 0.591-1.228;P = 0.390)。仅在单变量分析中,BB与长期全因死亡率降低相关(20%对28%;对数秩p = 0.023)。总之,BB和BB-AMIO在5年时与室性快速心律失常复发的风险相当。