心房颤动增加了植入式心脏复律除颤器受者复发性室性心动过速/心室颤动的风险。

Atrial fibrillation increases the risk of recurrent ventricular tachyarrhythmias in implantable cardioverter defibrillator recipients.

机构信息

First Department of Medicine, University Medical Centre Mannheim (UMM), Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany.

出版信息

Arch Cardiovasc Dis. 2021 Jun-Jul;114(6-7):443-454. doi: 10.1016/j.acvd.2020.12.010. Epub 2021 May 7.

DOI:10.1016/j.acvd.2020.12.010

PMID:33967015

Abstract

BACKGROUND

Data regarding recurrences of ventricular tachyarrhythmias in implantable cardioverter defibrillator (ICD) recipients according to atrial fibrillation is limited.

OBJECTIVE

To assess the prognostic impact of atrial fibrillation on recurrences of ventricular tachyarrhythmias in implantable cardioverter defibrillator recipients.

METHODS

A large retrospective registry was used, including all ICD recipients with episodes of ventricular tachycardia or fibrillation from 2002 to 2016. Patients with atrial fibrillation were compared to those without atrial fibrillation. The primary endpoint was first recurrence of ventricular tachyarrhythmias at 5 years. Secondary endpoints comprised recurrences of ICD-related therapies, first cardiac rehospitalization and all-cause mortality at 5 years. Cox regression, Kaplan-Meier and propensity score-matching analyses were applied.

RESULTS

A total of 592 consecutive ICD recipients were included (33% with atrial fibrillation). Atrial fibrillation was associated with reduced freedom from recurrent ventricular tachyarrhythmias (42% vs. 50%, log-rank P=0.004; hazard ratio 1.445, 95% confidence interval 1.124-1.858), mainly attributable to recurrent ventricular fibrillation in secondary-preventive ICD recipients. Accordingly, atrial fibrillation was associated with reduced freedom from first appropriate ICD therapies (31% vs. 42%, log-rank P=0.001; hazard ratio 1.598, 95% confidence interval 1.206-2.118). Notably, the primary endpoint of freedom from first episode of recurrent ventricular tachyarrhythmias was still reduced in those with atrial fibrillation compared to those without atrial fibrillation after propensity score matching. Regarding secondary endpoints, patients with atrial fibrillation still showed a trend towards reduced freedom from appropriate ICD therapies.

CONCLUSIONS

Atrial fibrillation was associated with increased rates of recurrent ventricular tachyarrhythmias and appropriate device therapies in ICD recipients with ventricular tachyarrhythmias.

摘要

背景

有关植入式心律转复除颤器（ICD）受者心房颤动时室性心动过速/心室颤动复发的数据有限。

目的

评估心房颤动对植入式心律转复除颤器受者室性心动过速/心室颤动复发的预后影响。

方法

使用大型回顾性登记研究，纳入 2002 年至 2016 年期间所有因室性心动过速或心室颤动而接受 ICD 治疗的患者。比较心房颤动患者与无心房颤动患者。主要终点为 5 年内首次发生室性心律失常复发。次要终点包括 5 年内 ICD 相关治疗、首次心脏再入院和全因死亡率的复发。应用 Cox 回归、Kaplan-Meier 和倾向评分匹配分析。

结果

共纳入 592 例连续 ICD 受者（33%患有心房颤动）。心房颤动与无复发性室性心动过速/心室颤动的自由（42% vs. 50%，log-rank P=0.004；风险比 1.445，95%置信区间 1.124-1.858）降低相关，主要归因于二级预防 ICD 受者中复发性心室颤动。相应地，心房颤动与无首次适当 ICD 治疗的自由相关（31% vs. 42%，log-rank P=0.001；风险比 1.598，95%置信区间 1.206-2.118）。值得注意的是，在倾向评分匹配后，与无心房颤动患者相比，有心房颤动患者的首次复发性室性心动过速/心室颤动事件无复发的主要终点仍较低。关于次要终点，心房颤动患者的适当 ICD 治疗仍有减少的趋势。