Long-term clinical course of patients after termination of ventricular tachyarrhythmia by an implanted defibrillator
Long-term clinical course of patients after termination of ventricular tachyarrhythmia by an implanted defibrillator
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DOI：
10.1161/01.cir.0000150390.04704.b7
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发表时间：
2004-12-21
期刊：
影响因子：
37.8
通讯作者：
Elkin, AD
中科院分区：
文献类型：
--
作者：
Moss, AJ;Greenberg, H;Elkin, AD
背景-植入式心律转复除颤器（ICD）可提高高危心脏病患者的生存率。从MADIT-II试验数据库的分析探讨了长期的临床过程和随后的死亡风险的患者终止后，危及生命的室性快速性心律失常的ICD.Methods和结果-生命表生存分析进行，比例风险回归分析用于评估的贡献基线临床因素和时间依赖性除颤器治疗的死亡率在长期随访。在植入ICD的720例患者中（平均随访21个月），169例患者接受了701次抗心律失常器械治疗，以治疗室性快速性心律失常。很少有基线特征区分首次室性心动过速发作接受适当ICD治疗的患者。首次治疗室性心动过速（VT）或室颤（VF）后至少1年的生存率为80%。在终止VT和VF的适当治疗中存活的患者中，任何原因导致死亡的风险比为3.4（P < 0.001）和3.3（P = 0.01），与未接受ICD治疗的患者相比，在首次成功的ICD治疗VF后，心力衰竭和晚期非猝死的发生率较高。ICD对VT或VF的成功适当治疗与心律失常终止后1年80%的生存率相关。这些患者在VT或VF器械终止后发生心力衰竭和非心源性猝死的风险增加，应在长期随访期间特别关注进行性左心室功能障碍的预防和管理。
Background - The implanted cardioverter defibrillator (ICD) improves survival in high-risk cardiac patients. This analysis from the MADIT-II trial database examines the long-term clinical course and subsequent mortality risk of patients after termination of life-threatening ventricular tachyarrhythmias by an ICD.Methods and Results - Life-table survival analysis was performed, and proportional hazards regression analysis was used to evaluate the contribution of baseline clinical factors and time-dependent defibrillator therapy to mortality during long-term follow-up. Of 720 patients with an ICD ( average follow-up 21 months), 169 patients received 701 antiarrhythmic device therapies for ventricular tachyarrhythmias. Few baseline characteristics distinguished patients who received appropriate ICD therapy for their first ventricular tachyarrhythmic episode. The probability of survival for at least 1 year after first therapy for ventricular tachycardia (VT) or ventricular fibrillation (VF) was 80%. The hazard ratios for the risk of death due to any cause in those who survived appropriate therapy for termination of VT and VF were 3.4 ( P < 0.001) and 3.3 ( P = 0.01), respectively, compared with those who survived without receiving ICD therapy, with a high frequency of heart failure and late nonsudden cardiac death after first successful ICD therapy for VF.Conclusions - Successful appropriate therapy by an ICD for VT or VF is associated with 80% survival at 1 year after arrhythmia termination. These patients are at increased risk for heart failure and nonsudden cardiac death after device termination of VT or VF and should receive special attention for the prevention and management of progressive left ventricular dysfunction during long-term follow-up.