Cardiology, Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
Cardiology, Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland.
Heart. 2023 Jul 12;109(15):1146-1152. doi: 10.1136/heartjnl-2022-321739.
Implantable cardioverter-defibrillators (ICDs) can prevent sudden cardiac death due to ventricular arrhythmias in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC). The aim of our study was to assess the cumulative burden, evolution and potential triggers of appropriate ICD shocks during long-term follow-up, which may help to reduce and further refine individual arrhythmic risk in this challenging disease.
This retrospective cohort study included 53 patients with definite ARVC according to the 2010 Task Force Criteria from the multicentre Swiss ARVC Registry with an implanted ICD for primary or secondary prevention. Follow-up was conducted by assessing all available patient records from patient visits, hospitalisations, blood samples, genetic analysis, as well as device interrogation and tracings.
Fifty-three patients (male 71.7%, mean age 43±2.2 years, genotype positive 58.5%) were analysed during a median follow-up of 7.9 (IQR 10) years. In 29 (54.7%) patients, 177 appropriate ICD shocks associated with 71 shock episodes occurred. Median time to first appropriate ICD shock was 2.8 (IQR 3.6) years. Long-term risk of shocks remained high throughout long-term follow-up. Shock episodes occurred mainly during daytime (91.5%, n=65) and without seasonal preference. We identified potentially reversible triggers in 56 of 71 (78.9%) appropriate shock episodes, the main triggers representing physical activity, inflammation and hypokalaemia.
The long-term risk of appropriate ICD shocks in patients with ARVC remains high during long-term follow-up. Ventricular arrhythmias occur more often during daytime, without seasonal preference. Reversible triggers are frequent with the most common triggers for appropriate ICD shocks being physical activity, inflammation and hypokalaemia in this patient population.
植入式心脏复律除颤器（ICD）可预防心律失常性右心室心肌病（ARVC）患者因室性心律失常导致的心脏性猝死。我们的研究目的是评估长期随访中适当 ICD 电击的累积负担、演变和潜在触发因素，这可能有助于降低并进一步细化该挑战性疾病中个体的心律失常风险。
这项回顾性队列研究纳入了瑞士多中心 ARVC 注册中心根据 2010 年工作组标准诊断为明确 ARVC 并植入 ICD 进行一级或二级预防的 53 例患者。通过评估患者就诊、住院、血液样本、基因分析以及设备检测和跟踪的所有可用患者记录来进行随访。
在中位随访 7.9（IQR 10）年期间，对 53 例患者（男性占 71.7%，平均年龄 43±2.2 岁，阳性基因型占 58.5%）进行了分析。在 29 例（54.7%）患者中，共发生 177 次与 71 次电击事件相关的适当 ICD 电击。首次适当 ICD 电击的中位时间为 2.8（IQR 3.6）年。在长期随访过程中，电击的长期风险仍然很高。电击事件主要发生在白天（91.5%，n=65），没有季节性偏好。在 71 次适当电击事件中，我们发现了 56 次（78.9%）可能为可逆转的触发因素，主要触发因素为体力活动、炎症和低钾血症。
在长期随访中，ARVC 患者适当 ICD 电击的长期风险仍然很高。室性心律失常更常发生在白天，没有季节性偏好。可逆转的触发因素很常见，最常见的适当 ICD 电击触发因素是该患者人群中的体力活动、炎症和低钾血症。
