First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, 47 Ziołowa St., 40-635 Katowice, Poland.
Medicina (Kaunas). 2024 Oct 10;60(10):1662. doi: 10.3390/medicina60101662.
: Understanding the underlying causes of implantable cardioverter-defibrillator (ICD) discharges is vital for effective management. This study aimed to evaluate the characteristics of patients admitted following ICD discharge, focusing on myocardial ischemia as a potential exacerbating factor and potential risk factors for VT recurrence. : This retrospective, single-center study included 81 patients with high energy discharge from cardiac implantable electronic device admitted urgently to the cardiology department from 2015 to 2022. The exclusion criterion was ST-segment elevation acute coronary syndrome. Data were collected anonymously from electronic medical records. Patients were categorized based on coronary angiography, percutaneous angioplasty, presence of significant stenosis, recurrent ventricular tachycardia (VT), and catheter ablation. Clinical variables, including demographic data, echocardiographic parameters, and pharmacotherapy, were analyzed. The primary endpoint was the recurrence of VT during in-hospital stay. : Among 81 patients, predominantly male (86.4%), with a mean age of 63.6 years, 55 (67.9%) had coronary artery disease (CAD) as the primary etiology for ICD implantation. Coronary angiography was performed in 34 patients (42.0%) and showed significant stenosis (>50%) in 18 (41.8%) patients, while 8 (26.0%) individuals underwent percutaneous coronary intervention (PCI). Recurrent VT occurred in 21 subjects (26.3%), while ventricular catheter ablation was performed in 36 patients (44.0%). Referral for urgent coronary angiography was associated with presence of diabetes ( = 0.028) and hyperlipidemia ( = 0.022). Logistic regression analysis confirmed NYHA symptomatic class (OR 4.63, = 0.04) and LVH (OR 10.59, = 0.049) were independently associated with relapse of VT. CAD patients underwent catheter ablation more frequently ( = 0.001) than those with dilated cardiomyopathy. : The study showed a low referral rate for coronary angiography among patients with ICD discharge. Presence of LVH and preexisting symptomatic class influence arrhythmia recurrence. Understanding these associations can guide personalized management strategies for ICD recipients.
了解植入式心脏复律除颤器 (ICD) 放电的根本原因对于有效管理至关重要。本研究旨在评估 ICD 放电后住院患者的特征，重点关注心肌缺血作为潜在的加重因素和 VT 复发的潜在危险因素。
这项回顾性、单中心研究纳入了 2015 年至 2022 年期间因心脏植入式电子设备高能量放电紧急入住心内科的 81 例患者。排除标准为 ST 段抬高型急性冠状动脉综合征。数据匿名从电子病历中收集。根据冠状动脉造影、经皮血管成形术、存在显著狭窄、复发性室性心动过速 (VT) 和导管消融术对患者进行分类。分析临床变量，包括人口统计学数据、超声心动图参数和药物治疗。主要终点是住院期间 VT 的复发。
在 81 例患者中，主要为男性 (86.4%)，平均年龄为 63.6 岁，55 例 (67.9%) 因冠状动脉疾病 (CAD) 作为 ICD 植入的主要病因。对 34 例患者进行了冠状动脉造影，其中 18 例 (41.8%) 患者存在显著狭窄 (>50%)，8 例 (26.0%) 患者进行了经皮冠状动脉介入治疗 (PCI)。21 例患者出现复发性 VT，36 例患者进行了心室导管消融术 (44.0%)。紧急冠状动脉造影的转诊与糖尿病 ( = 0.028) 和高脂血症 ( = 0.022) 有关。Logistic 回归分析证实 NYHA 症状分级 (OR 4.63， = 0.04) 和 LVH (OR 10.59， = 0.049) 与 VT 复发独立相关。CAD 患者更频繁地接受导管消融术 ( = 0.001)，而扩张型心肌病患者则较少。
该研究表明，ICD 放电后患者的冠状动脉造影转诊率较低。LVH 和预先存在的症状分级会影响心律失常的复发。了解这些关联可以为 ICD 接受者的个性化管理策略提供指导。
