Priori S G, Paganini V, Boccalatte L, Schwartz P J
Clinica Medica Generale e Terapia Medica, Università di Milano.
G Ital Cardiol. 1995 Feb;25(2):149-58.
The primary aim of U-CARE (Unexplained Cardiac Arrest Registry of Europe) is to collect clinical information on survivors about a documented episode of idiopathic ventricular fibrillation (IVF) and to follow these patients (pts) prospectively to acquire information on 1) recurrence of malignant arrhythmias or cardiac arrest, 2) development of a previously non obvious organic heart disease, 3) potential difference in outcome in pts treated with different drugs or devices.
Within April 15th, 1994, eighty-six pts have been enrolled, 65 males and 21 females. The mean age at the time of the first cardiac arrest was 35 +/- 15 years. Clinical evaluation revealed "minor" functional or anatomical abnormalities in 14 subjects and they were excluded from the analysis. In the remaining 72 pts, no abnormalities were found at echocardiogram, Holter, angiography, exercise stress test. At the electrophysiologic study 35/68 pts were inducible. Thirty-eight pts received pharmacologic therapy, 28 an implantable defibrillator (ICD), three pts received both an ICD and drug therapy and three were left untreated. Follow-up data are available for 37 pts with a mean follow-up of 4.4 +/- 2.6 years. No patient had evidence of structural heart disease. Twenty-three pts remained asymptomatic, 12 (32%) had a recurrence of syncope or cardiac arrest: three died suddenly and 2 were defibrillated by the ICD. This study that represents the largest experience in IVF, shows: 1) all patients remained free from any organic heart disease at follow-up, 2) they have a high risk of recurrence of major arrhythmic events.
An ICD implant would be appropriate in this population, at least until data on the efficacy of the pharmacologic therapy will be available.
欧洲不明原因心脏骤停登记处（U-CARE）的主要目的是收集特发性室颤（IVF）发作幸存者的临床信息，并对这些患者进行前瞻性随访，以获取以下信息：1）恶性心律失常或心脏骤停的复发情况；2）先前未发现的器质性心脏病的发展情况；3）接受不同药物或器械治疗的患者在预后方面的潜在差异。
在1994年4月15日前，共纳入了86例患者，其中男性65例，女性21例。首次心脏骤停时的平均年龄为35±15岁。临床评估发现14例受试者存在“轻微”的功能或解剖异常，这些患者被排除在分析之外。在其余72例患者中，超声心动图、动态心电图、血管造影、运动负荷试验均未发现异常。在电生理检查中，68例患者中有35例可诱发心律失常。38例患者接受了药物治疗，28例植入了植入式心脏除颤器（ICD），3例患者同时接受了ICD和药物治疗，3例未接受治疗。37例患者有随访数据，平均随访时间为4.4±2.6年。所有患者均无结构性心脏病证据。23例患者无症状，12例（32%）出现晕厥或心脏骤停复发：3例猝死，2例被ICD除颤。这项代表IVF最大经验的研究表明：1）随访期间所有患者均未患任何器质性心脏病；2）他们发生主要心律失常事件复发的风险很高。
在该人群中植入ICD是合适的，至少在获得药物治疗疗效的数据之前是合适的。
