Wiedmann Felix, Ince Hüseyin, Stellbrink Christoph, Kleemann Thomas, Eckardt Lars, Brachmann Johannes, Gonska Bernd-Dieter, Kääb Stefan, Perings Christian A, Jung Werner, Lugenbiel Patrick, Hochadel Matthias, Senges Jochen, Frey Norbert, Schmidt Constanze
Department of Cardiology, UniversityHospital Heidelberg, DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, Heidelberg University, Heidelberg, Germany, HCR, Heidelberg Center for Heart Rhythm Disorders, UniversityHospital Heidelberg, Heidelberg, Germany.
Department of Cardiology, Vivantes Klinikum Am Urban and Im Friedrichshain, Berlin, Germany, Rostock University, Rostock, Germany.
Heart Rhythm. 2023 Apr;20(4):501-509. doi: 10.1016/j.hrthm.2022.12.009. Epub 2022 Dec 10.
Because of its antiarrhythmic potency and due to the lack of alternatives, amiodarone is often used for antiarrhythmic therapy in patients with implantable cardioverter-defibrillator (ICD) or cardiac resynchronization therapy-defibrillator systems. To date, robust data on the safety and clinical benefit of amiodarone therapy in these patients are missing.
The purpose of this study was to assess the periprocedural and postprocedural outcomes of combined therapy with beta-blockers plus amiodarone compared to treatment with single beta-blockers in the "real-life" cohort of ICD recipients of the German DEVICE registry.
A total of 4499 patients who underwent ICD implantation, revision, or upgrade in 49 centers participating in the German DEVICE registry were enrolled from March 2007 to February 2014.
Amiodarone had no significant effect on the success of defibrillation testing. Early implantation-associated complications were similar between the groups. However, 1-year overall mortality was significantly higher in the beta-blocker plus amiodarone cohort (adjusted hazard ratio 2.09; P <.001). Interestingly, among the surviving patients, amiodarone was not associated with a significantly reduced risk of ICD discharges or syncopal events. Furthermore, the occurrence of ventricular tachycardia (VT) storm or incessant VTs and the number of patients scheduled for intracardiac ablation did not differ among both groups, whereas the rate of rehospitalization was lower in the cohort with only beta-blockers.
Although amiodarone has no adverse effect on the success of defibrillation testing, our data suggest an increased all-cause mortality under amiodarone therapy, especially in the subgroups of patients with sinus rhythm or severely reduced left ventricular function. In surviving patients, rates of arrhythmic events were comparable.
由于胺碘酮具有抗心律失常的效力且缺乏替代药物，它常用于植入式心脏复律除颤器（ICD）或心脏再同步治疗除颤器系统患者的抗心律失常治疗。迄今为止，关于胺碘酮治疗这些患者的安全性和临床益处的可靠数据尚缺。
本研究的目的是在德国DEVICE注册研究的“真实世界”ICD植入患者队列中，评估β受体阻滞剂联合胺碘酮治疗与单用β受体阻滞剂治疗相比的围手术期和术后结局。
2007年3月至2014年2月，从参与德国DEVICE注册研究的49个中心纳入了4499例行ICD植入、修订或升级的患者。
胺碘酮对除颤测试的成功率无显著影响。两组早期植入相关并发症相似。然而，β受体阻滞剂加胺碘酮组的1年总死亡率显著更高（校正风险比2.09；P<.001）。有趣的是，在存活患者中，胺碘酮与ICD放电或晕厥事件风险的显著降低无关。此外，两组室性心动过速（VT）风暴或持续性VT的发生率以及计划进行心内消融的患者数量无差异，而仅用β受体阻滞剂组的再住院率更低。
尽管胺碘酮对除颤测试的成功率无不良影响，但我们的数据表明胺碘酮治疗下全因死亡率增加，尤其是在窦性心律或左心室功能严重降低的患者亚组中。在存活患者中，心律失常事件发生率相当。
Zotero 插件