心房颤动和房扑行体外心脏转复后心血管植入式电子设备再干预的长期风险：一项全国性队列研究。
Long-term risk of cardiovascular implantable electronic device reinterventions following external cardioversion of atrial fibrillation and flutter: A nationwide cohort study.
机构信息
Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; Department of Hematology, Aalborg University Hospital, Clinical Cancer Research Center, Aalborg, Denmark.
Department of Anesthesia and Intensive Care Medicine, Aalborg University Hospital, Aalborg, Denmark.
出版信息
Heart Rhythm. 2023 Sep;20(9):1227-1235. doi: 10.1016/j.hrthm.2023.03.024. Epub 2023 Mar 23.
BACKGROUND
External cardioversion (ECV) is an essential part of rhythm control of atrial fibrillation and flutter in patients with and without cardiovascular implantable electronic devices (CIEDs). Long-term follow-up data on ECV-related CIED dysfunctions are limited.
OBJECTIVE
The purpose of this study was to investigate the risk of CIED reintervention following ECV in a nationwide cohort.
METHODS
We identified CIED implants and surgical reinterventions from 2005 to 2021 in the Danish Pacemaker and ICD Register. We included CIED patients undergoing ECV from 2010 to 2019 from the Danish National Patient Registry. For each ECV-exposed generator, 5 matched generators without ECV were identified, and for each ECV-exposed lead, 3 matched leads were identified. The primary endpoints were generator replacement and lead reintervention.
RESULTS
We compared 2582 ECV-exposed patients with 12,910 matched patients with a pacemaker (47%), implantable cardioverter-defibrillator (ICD) (29%), cardiac resynchronization therapy-pacemaker (6%), or cardiac resynchronization therapy-defibrillator (18%). During 2 years of follow-up, 210 ECV-exposed generators (8.1%) vs 670 matched generators (5.2%) underwent replacements, and 247 ECV-exposed leads (5.6%) vs 306 matched leads (2.3%) underwent reintervention. Unadjusted hazard ratios were 1.61 (95% confidence interval [CI] 1.37-1.91; P <.001) for generator replacement and 2.39 (95% CI 2.01-2.85; P <.001) for lead reintervention. One-year relative risks were 1.73 (95% CI 1.41-2.12; P <.001) for generator replacement and 2.85 (95% CI 2.32-3.51; P <.001) for lead reintervention, and 2-year relative risks were 1.39 (95% CI 1.19-1.63; P <.001) and 2.18 (95% CI 1.84-2.57; P <.001), respectively.
CONCLUSION
ECV in patients with a CIED is associated with a higher risk of generator replacement and lead reintervention. The risks of reinterventions were more pronounced within the first year after cardioversion.
背景
体外心脏复律（ECV）是伴有和不伴有心血管植入式电子设备（CIED）的心房颤动和扑动患者节律控制的重要组成部分。关于 ECV 相关 CIED 功能障碍的长期随访数据有限。
目的
本研究旨在调查全国队列中 ECV 后 CIED 再干预的风险。
方法
我们从丹麦起搏器和 ICD 登记处确定了 2005 年至 2021 年的 CIED 植入和手术再干预。我们从丹麦国家患者登记处确定了 2010 年至 2019 年期间接受 ECV 的 CIED 患者。对于每个接受 ECV 的发生器，我们识别了 5 个匹配的未接受 ECV 的发生器，对于每个接受 ECV 的导联，我们识别了 3 个匹配的导联。主要终点是发生器更换和导联再干预。
结果
我们比较了 2582 例接受 ECV 的患者和 12910 例匹配的起搏器（47%）、植入式心脏复律除颤器（ICD）（29%）、心脏再同步治疗起搏器（6%）或心脏再同步治疗除颤器（18%）患者。在 2 年的随访期间，210 例接受 ECV 的发生器（8.1%）与 670 例匹配的发生器（5.2%）进行了更换，247 例接受 ECV 的导联（5.6%）与 306 例匹配的导联（2.3%）进行了再干预。未调整的危险比分别为发生器更换 1.61（95%置信区间 [CI] 1.37-1.91；P<0.001）和导联再干预 2.39（95% CI 2.01-2.85；P<0.001）。发生器更换的 1 年相对风险为 1.73（95% CI 1.41-2.12；P<0.001），导联再干预的 1 年相对风险为 2.85（95% CI 2.32-3.51；P<0.001），2 年相对风险分别为 1.39（95% CI 1.19-1.63；P<0.001）和 2.18（95% CI 1.84-2.57；P<0.001）。
结论
CIED 患者的 ECV 与发生器更换和导联再干预的风险增加相关。在心脏复律后的第一年，再干预的风险更为明显。
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