抗心律失常治疗与致心律失常性右心室心肌病累积性室性心律失常风险。

Antiarrhythmic therapy and risk of cumulative ventricular arrhythmias in arrhythmogenic right ventricle cardiomyopathy.

机构信息

Cardiothoracovascular Department, Cattinara Hospital, Azienda Sanitaria Universitaria Giuliano Isontina and University of Trieste, Trieste, Italy.

Biostatistics Unit, Department of Medical Sciences, University of Trieste, Trieste, Italy.

出版信息

Int J Cardiol. 2021 Jul 1;334:58-64. doi: 10.1016/j.ijcard.2021.04.069. Epub 2021 May 5.

DOI:10.1016/j.ijcard.2021.04.069

PMID:33961942

Abstract

OBJECTIVES

The aim of our study was to investigate the benefit of antiarrhythmic drugs (AAD) - beta-blockers, sotalol or amiodarone - in a cohort of Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC) patients with long-term longitudinal follow up.

BACKGROUND

AAD are prescribed in ARVC to prevent ventricular arrhythmias and control symptoms. However, there are no controlled clinical trials and knowledges regarding the efficacy of AAD in ARVC are limited.

METHODS

The study population included 123 patients with definite diagnosis of ARVC and ≥ 2 clinical evaluations. The primary outcome was a composite of sudden cardiac death (SCD)/recurrent major ventricular arrythmias (MVA): sudden cardiac arrest, sustained ventricular tachycardia (VT) and appropriate implantable cardioverter defibrillator interventions, including recurrent events in patients with >1 MVA. Time to first event (SCD or MVA) was considered as secondary composite endpoint.

RESULTS

Sixteen patients were taking AAD at baseline and 75 started at least one AAD during a median follow-up of 132 months [61-255]. A total of 37 patients experienced ≥1 MVA with a total count of 83 recurrent MVA. After adoption of a propensity score analysis, no AAD were associated with lower risk of recurrent MVA. However, if dosage of AAD was considered, beta-blockers at >50% target dose were associated with a significant reduction in the risk of MVA compared to patients not taking beta-blockers (HR 0.10, 95% CI 0.02-0.46, p = 0.004).

CONCLUSIONS

In a large cohort of ARVC patients with a long-term follow-up, only beta-blockers administrated at >50% target dose were associated with lower risk of SCD/recurrent MVA.

摘要

目的

本研究旨在通过长期纵向随访，调查抗心律失常药物（AAD）-β受体阻滞剂、索他洛尔或胺碘酮在心律失常性右室心肌病（ARVC）患者中的获益。

背景

ARVC 患者中开具 AAD 是为了预防室性心律失常和控制症状。然而，目前尚无对照临床试验，AAD 在 ARVC 中的疗效知之甚少。

方法

研究人群包括 123 例明确诊断为 ARVC 且≥2 次临床评估的患者。主要终点是心脏性猝死（SCD）/复发性主要室性心律失常（MVA）的复合终点：心脏骤停、持续性室性心动过速（VT）和适当的植入式心脏复律除颤器干预，包括有≥1 次 MVA 的患者的复发事件。首次事件（SCD 或 MVA）时间被视为次要复合终点。

结果

16 例患者在基线时服用 AAD，75 例患者在中位随访 132 个月[61-255]期间至少服用了一种 AAD。共有 37 例患者发生≥1 次 MVA，共发生 83 次复发性 MVA。采用倾向评分分析后，AAD 与复发性 MVA 的风险降低无关。然而，如果考虑 AAD 的剂量，β受体阻滞剂的目标剂量＞50%与未服用β受体阻滞剂的患者相比，MVA 的风险显著降低（HR 0.10，95%CI 0.02-0.46，p=0.004）。