Kida Hirota, Morishima Toshitaka, Uza Eiji, Yamamoto Hironori, Yasui Taku, Fujita Masashi, Miyashiro Isao
Department of Clinical Engineering Osaka International Cancer Institute Osaka Japan.
Cancer Control Center Osaka International Cancer Institute Osaka Japan.
J Arrhythm. 2025 May 19;41(3):e70093. doi: 10.1002/joa3.70093. eCollection 2025 Jun.
Implantable cardioverter-defibrillator (ICD) has been demonstrated to improve survival outcomes compared to amiodarone. However, this effectiveness in cancer patients remains unclear. Given the complexity of cardiovascular management in this population, including cancer stage considerations, we evaluated the relative effectiveness of ICD versus amiodarone in cancer patients.
We linked cancer registry data with administrative records to identify patients newly prescribed amiodarone or who underwent ICD implantation between 2010 and 2015 at 36 hospitals in Osaka Prefecture, Japan. Among 161,125 cancer patients, 339 met the inclusion criteria (amiodarone: = 281; ICD: = 58), with a median follow-up of 762 days. Kaplan-Meier analysis revealed that the ICD group had a significantly reduced risk of all-cause mortality compared to the Amiodarone group (Log-rank test, < .003). Multivariable Cox proportional hazard regression model showed that ICD was an independent prognostic factor (Hazard ratio: 0.47, 95% confidence interval: 0.29-0.79, = .004). These results were confirmed in a propensity-matched analysis. Among patients with cancer stage: in situ or localized, no significant difference in survival risk was observed between the ICD and Amiodarone groups, and ICD was not significantly associated with all-cause death. Conversely, among patients with cancer stage: regional or distant, the ICD group had a significantly reduced risk of all-cause death compared to the Amiodarone group, and ICD was an independent prognostic factor.
In cancer patients, ICD may improve long-term prognosis compared to amiodarone, especially in patients with advanced cancer stages.
与胺碘酮相比，植入式心律转复除颤器（ICD）已被证明可改善生存结局。然而，其在癌症患者中的有效性仍不明确。鉴于该人群心血管管理的复杂性，包括癌症分期因素，我们评估了ICD与胺碘酮在癌症患者中的相对有效性。
我们将癌症登记数据与行政记录相链接，以识别2010年至2015年间在日本大阪府36家医院新开具胺碘酮处方或接受ICD植入的患者。在161,125名癌症患者中，339名符合纳入标准（胺碘酮组：=281；ICD组：=58），中位随访时间为762天。Kaplan-Meier分析显示，与胺碘酮组相比，ICD组全因死亡率风险显著降低（对数秩检验，<0.003）。多变量Cox比例风险回归模型显示，ICD是一个独立的预后因素（风险比：0.47，95%置信区间：0.29-0.79，=0.004）。这些结果在倾向匹配分析中得到证实。在原位或局限性癌症分期的患者中，ICD组和胺碘酮组的生存风险无显著差异，且ICD与全因死亡无显著关联。相反，在区域或远处癌症分期的患者中，与胺碘酮组相比，ICD组全因死亡风险显著降低，且ICD是一个独立的预后因素。
在癌症患者中，与胺碘酮相比，ICD可能改善长期预后，尤其是在癌症晚期患者中。
