Clinical predictors and prognostic significance of electrical storm in patients with implantable cardioverter defibrillators
Clinical predictors and prognostic significance of electrical storm in patients with implantable cardioverter defibrillators
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DOI：
10.1093/eurheartj/ehi726
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发表时间：
2006-03-01
影响因子：
39.3
通讯作者：
Kacet, S
中科院分区：
文献类型：
--
作者：
Brigadeau, F;Kouakam, C;Kacet, S
植入型心律转复除颤器（ICD）治疗患者的电风暴（ES）和临床结局的预测因素数据不足。本研究的目的是描绘一个亚组的患者可能会遇到ES和确定的影响ES对死亡率ICD recipients.Methods和结果的基线特征307 ICD治疗的患者进行了回顾性分析。ES定义为24小时内发生两次或多次室性快速性心律失常，导致立即进行电治疗（抗心动过速起搏和/或电击），间隔一段窦性心律。在中位随访826天（四分位数间1141天）期间，将123例共发生294次ES（中位数2次ES/患者，范围1-9）的患者的临床特征和生存率与184例无ES患者的临床特征和生存率进行比较。ICD植入后首次ES发生的中位精算持续时间为1417天[95%置信区间（CI）1061-2363]，无ES患者的中位随访时间为816天（7-4642天）。单变量分析发现，年龄较大、左心室射血分数（LVEF）降低、室性心动过速（VT）作为指标心律失常、慢性肾功能衰竭和缺乏降脂药物是与ES风险增加显著相关的变量。多变量考克斯分析证实了慢性肾衰竭[风险比（HR）1.54，95% CI 0.95-2.51，P=0.052]、VT（HR 2.20，95% CI 1.44-3.37，P=0.0003）和LVEF（HR 0.98，95% CI 0.97-0.99，P=0.027）的独立预测值。相比之下，糖尿病患者（HR 0.49，95% CI 0.27-0.90，P=0.022）受ES影响较小。两组患者的生存率无差异。结论ES是常见的，但不增加ICD患者的死亡率。严重收缩功能不全、慢性肾功能衰竭和VT作为初始心律失常的患者可能会发生ES。糖尿病患者受ES的影响较小。
Aims Insufficient data exists regarding predictors of electrical storms (ES) and clinical outcome in patients treated with an implantable cardioverter defibrillator (ICD). The purpose of this study was to delineate a subgroup of patients likely to experience ES and to determine the impact of ES on mortality in ICD recipients.Methods and results Baseline characteristics of 307 ICD-treated patients were retrospectively analysed. ES was defined as two or more ventricular tachyarrhythmias within 24 h leading to an immediate electrical therapy (antitachycardia pacing and/or shock), separated by a period of sinus rhythm. Clinical characteristics and survival of 123 patients experiencing a total of 294 episodes of ES (median 2 ES/patient, range 1-9), were compared with those of 184 ES-free patients during a median follow-up of 826 days (inter-quartile 1141 days). Median actuarial duration for the first ES occurrence after ICD implant was 1417 days [95% confidence interval (CI) 1061-2363] with a median follow-up of 816 days (7-4642 days) in ES-free patients. Univariate analysis identified older age, depressed left ventricular ejection fraction (LVEF), ventricular tachycardia (VT) as index arrhythmia, chronic renal failure and absence of lipid-lowering drugs as variables significantly associated with an increased risk of ES. Multivariable Cox analysis confirmed an independent predictive value for chronic renal failure [hazard ratio (HR) 1.54, 95% CI 0.95-2.51, P=0.052], VT (HR 2.20, 95% CI 1.44-3.37, P=0.0003), and LVEF (HR 0.98, 95% CI 0.97-0.99, P=0.027). In contrast, diabetics (HR 0.49, 95% CI 0.27-0.90, P=0.022) were less affected by ES. There was no difference in survival between both groups.Conclusion ES is frequent but does not increase mortality in ICD's recipients. Patients with severe systolic dysfunction, chronic renal failure and VT as initial arrhythmia are likely to experience ES. Diabetics are less affected by ES.