Trappe H J, Pfitzner P, Achtelik M, Fieguth H G
Department of Cardiology and Angiology, University Hospital Herne, Ruhr University Bochum, Germany.
Heart. 1997 Oct;78(4):364-70.
To determine whether implantable cardioverter-defibrillator (ICD) treatment is beneficial in elderly patients with life threatening ventricular tachyarrhythmias.
Since January 1984, ICDs were implanted in 450 patients to evaluate surgical risk, complications and mean survival in relation to patient age; 81 patients (18%) were < or = 50 years at the time of ICD implant, 254 patients (56%) were between 51 and 64 years, and the remaining 115 (26%) were > or = 65 years. Epicardial lead systems were implanted in 209 patients (46%), while transvenous lead systems were implanted in 241 (54%).
13 patients (3%) died perioperatively, more often after epicardial (11 of 209 patients, 5%) than after transvenous ICD implantation (one of 241 patients, < 1%) (p < 0.05). During a mean (SD) follow up of 28 (24) months (range < 1 to 114 months), 90 patients (20%) died. Of these, nine (2%) died from sudden arrhythmic death; five (1%) died suddenly, probably as a result of non-arrhythmic causes; 55 (12%) died from other cardiac causes (congestive heart failure, myocardial infarction); and 21 (5%) died from non-cardiac causes. The three, five, and seven year survival for arrhythmic mortality was 95% in patients < or = 50 years compared with a three year survival of 93% and a five and seven year survival of 91% in patients of 51 to 64 years, and a three, five, and seven year survival of 99% in patients > or = 65 years. 362 patients (80%) received ICD discharges (21 (43) shocks per patient), with a similar incidence among all three patient groups (< or = 50 years, 80%; 51 to 64 years, 81%; > or = 65 years, 79%). The time interval between ICD implant and the first ICD treatment was shorter in patients > or = 65 years (8 (8) months) than in patients between 51 and 64 years (11 (14) months) or < or = 50 years (11 (11) months) (p < 0.05). Survival time following first appropriate shock was 30 (24) months in patients < or = 50 years, 30 (26) months in patients of 51 to 64 years, and 19 (20) months in patients > or = 65 years.
Elderly patients benefit from ICD treatment, and survive for a considerable time after the first treatment. Therefore, elderly patients should be considered candidates for ICD implantation if life threatening ventricular tachy-arrhythmias are present.
确定植入式心脏复律除颤器（ICD）治疗对患有危及生命的室性快速心律失常的老年患者是否有益。
自1984年1月起，450例患者植入了ICD，以评估手术风险、并发症以及与患者年龄相关的平均生存期；81例患者（18%）在植入ICD时年龄小于或等于50岁，254例患者（56%）年龄在51至64岁之间，其余115例（26%）年龄大于或等于65岁。209例患者（46%）植入了心外膜导联系统，241例患者（54%）植入了经静脉导联系统。
13例患者（3%）在围手术期死亡，心外膜植入ICD后死亡的情况更为常见（209例患者中有11例，5%），高于经静脉植入ICD后的死亡情况（241例患者中有1例，<1%）（p<0.05）。在平均（标准差）28（24）个月的随访期内（范围<1至114个月），90例患者（20%）死亡。其中，9例（2%）死于心律失常性猝死；5例（1%）突然死亡，可能是由于非心律失常原因；55例（12%）死于其他心脏原因（充血性心力衰竭、心肌梗死）；21例（5%）死于非心脏原因。年龄小于或等于50岁患者心律失常性死亡的3年、5年和7年生存率为95%，51至64岁患者的3年生存率为93%，5年和7年生存率为91%，年龄大于或等于65岁患者的3年、5年和7年生存率为99%。362例患者（80%）接受了ICD电击治疗（每位患者平均21（43）次电击），三组患者中的发生率相似（小于或等于50岁，80%；51至64岁，81%；大于或等于65岁，79%）。年龄大于或等于65岁患者从ICD植入到首次ICD治疗的时间间隔（8（8）个月）短于51至64岁患者（11（14）个月）或小于或等于50岁患者（11（11）个月）（p<0.05）。首次适当电击后的生存时间，小于或等于50岁患者为30（24）个月，51至64岁患者为30（26）个月，大于或等于65岁患者为19（20）个月。
老年患者从ICD治疗中获益，且在首次治疗后能存活相当长的时间。因此，如果存在危及生命的室性快速心律失常，老年患者应被视为ICD植入的候选者。
