Mkoko Philasande, Solomon Kayla, Chin Ashley
Division of Cardiology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; Cardiac Clinic, Groote Schuur Hospital, Cape Town, South Africa. Email:
Cardiac Clinic, Groote Schuur Hospital, Cape Town, South Africa.
Cardiovasc J Afr. 2023;34(3):150-156. doi: 10.5830/CVJA-2022-039. Epub 2022 Aug 12.
In young patients without atherosclerotic coronary artery disease, the aetiology of sudden cardiac death (SCD) has been described in Europe and North America. However, there are important regional variations and there are limited data on the aetiology and outcome of SCD in South Africa. The objective of this study was to determine the profile and outcomes of young patients treated with implantable cardioverter defibrillators (ICDs) at a South African tertiary hospital.
This study was designed as a retrospective review of patients aged 35 years or younger implanted with ICDs at Groote Schuur Hospital.
During the study period, 38 patients younger than 35 years were implanted with ICDs. The mean (standard deviation) age at ICD implantation was 25.1 (7.6) years and 63.2% were male. A secondary-prevention ICD was implanted in 57.9% of the patient population, and primary prevention in the remaining 42.1%. Patients with secondary-prevention ICDs presented with ventricular tachycardia (59.1%), ventricular fibrillation (31.8%) and receipt of cardiopulmonary resuscitation but no recorded electrocardiograms (9.1%). Arrhythmogenic right ventricular cardiomyopathy (ARVC) was the leading cause of SCD in the secondary-prevention patient population (36.4%). Idiopathic dilated cardiomyopathy accounted for 50% of the primary-prevention patient population. After a median (interquartile range) follow up 32 (14-90) months, 7.9% died and 5.2% received a heart transplant; 42.1% of the study population received appropriate ICD shock therapies and 18.4% received inappropriate shock therapies.
In this single-centre study from South Africa, ARVC and repaired congenital heart disease were the leading causes of SCD in patients younger than 35 years treated with secondary-prevention ICDs. Primary-prevention ICDs were frequently implanted for idiopathic dilated cardiomyopathy.
在无动脉粥样硬化性冠状动脉疾病的年轻患者中，欧洲和北美已对心源性猝死（SCD）的病因进行了描述。然而，存在重要的地区差异，且南非关于SCD病因和结局的数据有限。本研究的目的是确定南非一家三级医院接受植入式心律转复除颤器（ICD）治疗的年轻患者的概况和结局。
本研究设计为对在格罗特·舒尔医院植入ICD的35岁及以下患者进行回顾性分析。
在研究期间，38例35岁以下患者植入了ICD。植入ICD时的平均（标准差）年龄为25.1（7.6）岁，63.2%为男性。57.9%的患者植入了二级预防ICD，其余42.1%为一级预防。接受二级预防ICD的患者表现为室性心动过速（59.1%）、心室颤动（31.8%）以及接受了心肺复苏但无记录心电图（9.1%）。致心律失常性右室心肌病（ARVC）是二级预防患者群体中SCD的主要原因（36.4%）。特发性扩张型心肌病占一级预防患者群体的50%。经过中位（四分位间距）32（14 - 90）个月的随访，7.9%的患者死亡，5.2%的患者接受了心脏移植；42.1%的研究人群接受了适当的ICD电击治疗，18.4%接受了不适当的电击治疗。
在这项来自南非的单中心研究中，ARVC和修复的先天性心脏病是接受二级预防ICD治疗的35岁以下患者SCD的主要原因。一级预防ICD常用于特发性扩张型心肌病。
