Selvarajah Karshana, Khan Parisha, Jahagirdar Nishat, Cannatà Antonio, Mukherjee Rahul, Bromage Daniel I, McDonagh Theresa, Murgatroyd Francis, Scott Paul A
Department of Cardiology King's College Hospital NHS Foundation Trust London UK.
School of Cardiovascular Medicine and Sciences, King's College London London UK.
J Arrhythm. 2024 Dec 22;41(1):e13204. doi: 10.1002/joa3.13204. eCollection 2025 Feb.
The most effective way to treat patients following a first ICD therapy is unclear. We hypothesised that following first ICD therapy, combining different treatment strategies would be associated with a reduction in the risk of subsequent therapy compared to single strategies alone.
Data was collected from consecutive patients undergoing ICD implantation at King's College Hospital between January 2009 and December 2019. We assessed the use of 7 specific treatment strategies, introduced after the 1st therapy-start/increase the dose of beta-blockers, prognostic heart failure medications, antiarrhythmic drugs as well as ICD reprogramming, ablation, ICD upgrade/revision and coronary revascularisation. We evaluated the association between these treatment strategies and the risk of a subsequent ICD therapy.
During a mean 50 months follow-up, 267 patients experienced 1st ICD therapy (212 appropriate and 55 inappropriate). Combining treatment strategies was associated with a significant reduction in the risk of subsequent therapy for appropriate therapy compared to 0/7 strategies (1st appropriate ICD therapy, 1/7 treatment strategy ( = 80), 43% lower risk and ≥2/7 treatment strategies ( = 73) 58% reduction, = <.001). This was also true for inappropriate therapy (1st inappropriate therapy, 1 treatment strategy ( = 22) 86% lower risk and ≥2/7 treatment strategies ( = 25), 94% reduction, < 0.001) compared to patients with 0/7 treatment strategies ( = 8).
An approach combining treatment strategies may be more effective than using single strategies alone to prevent subsequent therapy in patients presenting following a 1st ICD therapy.
首次植入植入式心律转复除颤器（ICD）治疗后患者的最有效治疗方法尚不清楚。我们假设，在首次ICD治疗后，与单独使用单一策略相比，联合不同的治疗策略将与降低后续治疗风险相关。
收集2009年1月至2019年12月在国王学院医院接受ICD植入的连续患者的数据。我们评估了首次治疗后引入的7种特定治疗策略的使用情况，即开始使用/增加β受体阻滞剂剂量、使用预后性心力衰竭药物、抗心律失常药物以及ICD重新编程、消融、ICD升级/修订和冠状动脉血运重建。我们评估了这些治疗策略与后续ICD治疗风险之间的关联。
在平均50个月的随访期间，267例患者接受了首次ICD治疗（212例为恰当治疗，55例为不恰当治疗）。与0/7种策略相比，联合治疗策略与恰当治疗后后续治疗风险的显著降低相关（首次恰当ICD治疗，1/7种治疗策略（n = 80），风险降低43%；≥2/7种治疗策略（n = 73），风险降低58%，P = <.001）。与0/7种治疗策略的患者（n = 8）相比，对于不恰当治疗也是如此（首次不恰当治疗，1种治疗策略（n = 22），风险降低86%；≥2/7种治疗策略（n = 25），风险降低94%，P < 0.001）。
对于首次接受ICD治疗后的患者，联合治疗策略的方法可能比单独使用单一策略更有效地预防后续治疗。
