Bänsch D, Brunn J, Castrucci M, Weber M, Gietzen F, Borggrefe M, Breithardt G, Block M
Department of Cardiology/Angiology and Institute for Research in Arteriosclerosis, Westfälische Wilhelms-University, Münster, Germany.
J Am Coll Cardiol. 1998 Mar 1;31(3):608-15. doi: 10.1016/s0735-1097(97)00543-3.
This retrospective study was undertaken to provide information on occurrence, risk prediction and prevention of syncope in patients with an implantable cardioverter-defibrillator (ICD).
ICDs effectively terminate ventricular tachycardia and fibrillation (VT/VF). Incapacitating symptoms, such as syncope, may still occur.
We performed a retrospective analysis of data from 421 patients (clinical history, outpatient chart reviews and episode data) with mean (+/-SD) follow-up of 26 +/- 18 months.
Of 421 patients, 229 (54.4%) had recurrent VT/VF, and 62 (14.7%) had syncope. The actuarial survival rate free of VT/VF was 58%, 45% and 37% and that for survival free of syncope was 90%, 85% and 81% at 12, 24 and 36 months after implantation, respectively. Once VT/VF had occurred, 76%, 68% and 62% of patients remained free of syncope during the following 12, 24 and 36 months, and 68%, 64% and 56% remained free of second syncope 12, 24 and 36 months after first syncope, respectively. In cases of syncope, the mean cycle length (CL) of VT was 251 +/- 56 ms. A low baseline left ventricular ejection fraction (LVEF), induction of fast VT (CL <300 ms) during programmed ventricular stimulation and chronic atrial fibrillation (AF) were associated with an increased risk of syncope. If the LVEF was >40%, fast VT had not been induced, and patients had no chronic AF; 96%, 92% and 92% of patients remained free of syncope after 12, 24 and 36 months, respectively. Once patients had a VT recurrence, syncope during the first VT and a high VT rate were the strongest risk predictors of future syncope.
Identification of patients with an ICD with a low and high risk of syncope seems to be feasible and might help as a guide to driving restrictions in such patients.
本回顾性研究旨在提供有关植入式心脏复律除颤器（ICD）患者晕厥的发生情况、风险预测及预防方面的信息。
ICD可有效终止室性心动过速和颤动（VT/VF）。但诸如晕厥等失能症状仍可能发生。
我们对421例患者的数据进行了回顾性分析（临床病史、门诊病历审查及发作数据），平均（±标准差）随访时间为26±18个月。
421例患者中，229例（54.4%）有复发性VT/VF，62例（14.7%）有晕厥。植入后12、24和36个月时，无VT/VF的精算生存率分别为58%、45%和37%，无晕厥的生存率分别为90%、85%和81%。一旦发生VT/VF，在接下来的12、24和36个月中，分别有76%、68%和62%的患者未发生晕厥，首次晕厥后12、24和36个月时，分别有68%、64%和56%的患者未发生再次晕厥。在晕厥病例中，VT的平均周长（CL）为251±56毫秒。低基线左心室射血分数（LVEF）、程控心室刺激期间诱发快速VT（CL<300毫秒）和慢性心房颤动（AF）与晕厥风险增加相关。如果LVEF>40%，未诱发快速VT，且患者无慢性AF；分别有96%、92%和92%的患者在12、24和36个月后未发生晕厥。一旦患者发生VT复发，首次VT期间的晕厥和高VT率是未来晕厥最强的风险预测因素。
识别ICD患者晕厥的低风险和高风险似乎是可行的，可能有助于指导此类患者的驾驶限制。
