Sweeney M O, Ruskin J N, Garan H, McGovern B A, Guy M L, Torchiana D F, Vlahakes G J, Newell J B, Semigran M J, Dec G W
Cardiac Arrhythmia Service, Massachusetts General Hospital, Harvard Medical School, Boston 02114, USA.
Circulation. 1995 Dec 1;92(11):3273-81. doi: 10.1161/01.cir.92.11.3273.
Implantable cardioverter/defibrillators (ICDs) may reduce sudden tachyarrhythmic death in patients with severe left ventricular dysfunction. It is uncertain whether this improves survival, particularly in patients awaiting cardiac transplantation.
The effect of treatment for spontaneous ventricular arrhythmias (ICD [n = 59], antiarrhythmic drugs [n = 53], or no antiarrhythmic treatment [n = 179]) on total mortality and mode of cardiac death was analyzed in 291 consecutive patients evaluated for cardiac transplantation between January 1986 and January 1995. There were 109 deaths (37.4%) (63 [21.6%] sudden, 40 [13.7%] nonsudden, and 6 [2.1%] noncardiac) during mean follow-up of 15 months (range, 1 to 118 months). Baseline clinical variables, medical therapies for heart failure, and actuarial rates of transplantation were similar between treatment groups. Kaplan-Meier sudden death rates were lowest in the ICD group, intermediate in the no antiarrhythmic treatment group, and highest in the drug treatment group throughout follow-up (12-month sudden death rates, 9.2%, 16.0%, and 34.7%, respectively; P = .004). Total mortality and nonsudden death rates did not differ. Cox proportional-hazards model revealed that antiarrhythmic drug treatment was associated with sudden death (relative risk, 2.1; 95% CI, 1.04 to 3.39; P = .04) and ICD was associated with nonsudden death (relative risk, 2.26; 95% CI, 1.12 to 4.62; P = .02).
Sudden death rates were lowest in patients treated with ICDs compared with drug treatment or no antiarrhythmic treatment. However, although ICDs reduced sudden death in selected high-risk patients with severe left ventricular dysfunction, the effect on long-term survival was limited, principally by high nonsudden death rates.
植入式心脏复律除颤器（ICD）可能降低严重左心室功能不全患者的快速心律失常性猝死风险。目前尚不确定这是否能提高生存率，尤其是在等待心脏移植的患者中。
分析了1986年1月至1995年1月期间连续291例接受心脏移植评估患者中，针对自发性室性心律失常的治疗（ICD治疗组[n = 59]、抗心律失常药物治疗组[n = 53]或未进行抗心律失常治疗组[n = 179]）对总死亡率和心脏死亡方式的影响。平均随访15个月（范围1至118个月）期间，共发生109例死亡（37.4%）（63例[21.6%]猝死、40例[13.7%]非猝死和6例[2.1%]非心脏性死亡）。各治疗组间的基线临床变量、心力衰竭的药物治疗以及移植的精算率相似。在整个随访过程中，ICD治疗组的Kaplan-Meier猝死率最低，未进行抗心律失常治疗组居中，药物治疗组最高（12个月猝死率分别为9.2%、16.0%和34.7%；P = .004）。总死亡率和非猝死率无差异。Cox比例风险模型显示，抗心律失常药物治疗与猝死相关（相对风险，2.1；95%可信区间，1.04至3.39；P = .04），ICD与非猝死相关（相对风险，2.26；95%可信区间，1.12至4.62；P = .02）。
与药物治疗或未进行抗心律失常治疗相比，ICD治疗患者的猝死率最低。然而，尽管ICD降低了部分严重左心室功能不全高危患者的猝死风险，但对长期生存的影响有限，主要原因是非猝死率较高。
