Survival After Implantable Cardioverter-Defibrillator Shocks.
Survival After Implantable Cardioverter-Defibrillator Shocks.
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DOI：
10.1016/j.jacc.2021.03.329
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发表时间：
2021-05-25
影响因子：
24
通讯作者：
Goldenberg I
中科院分区：
文献类型：
--
作者：
Aktaş MK;Younis A;Zareba W;Kutyifa V;Klein H;Daubert JP;Estes M;McNitt S;Polonsky B;Goldenberg I
关于植入式心律转复除颤器（ICD）电击对随后死亡率的影响，存在相互矛盾的数据。本研究的目的是确定导致ICD治疗的药物底物或治疗本身是否会增加死亡率。研究队列包括5，516名ICD接受者，他们入组了5项具有里程碑意义的ICD试验（MADIT-II、MADIT-RISK、MADIT-CRT、MADIT-RIT、RAID）。作者在4个单独的时间依赖性模型中评价了器械治疗与后续死亡率的相关性：模型I，ICD治疗类型;模型II，ICD治疗所针对的心律失常类型;模型III，随访期间所有心律失常和治疗类型的综合评估;模型IV，与重复ICD电击相关的增量风险。当按ICD治疗类型进行分析时（模型I），首次适当的ICD电击与后续死亡风险增加相关，随访期间伴随或不伴随发生不适当的电击（风险比[HR]：2.78和2.31; p < 0.001和p = 0.12），而单独的不适当休克与死亡风险无关。（HR：1.23; p = 0.42）。同样，ICD治疗室性心动过速（VT）≥200次/min或室颤（VF）（模型II）与VT <200次/分伴或不伴伴随治疗的死亡风险增加相关（HRs：2.25和2.62;均p < 0.001），而VT <200次/分的适当治疗或不适当治疗（无论病因如何）均未达到统计学显著性（均p > 0.10）。对随访期间所有治疗和心律失常类型的综合评估（模型III）显示，针对VF的适当ICD电击、针对快速VT（≥200次/分）的电击（无既往抗心动过速起搏（ATP））以及针对ATP失败后输送的快速VT的电击与后续死亡的最高风险相关（HR：均>2.8; p < 0.001）。最后，2次或2次以上ICD适当电击与首次ICD适当电击的风险增加无关（模型IV）。来自5项具有里程碑意义的ICD试验的综合数据表明，潜在的药物基质而不是ICD治疗是ICD接受者死亡率的更重要决定因素。
There are conflicting data on the impact of implantable cardioverter-defibrillator (ICD) shocks on subsequent mortality. The aim of this study was to determine whether the arrhythmic substrate leading to ICD therapy or the therapy itself increases mortality. The study cohort included 5,516 ICD recipients who were enrolled in 5 landmark ICD trials (MADIT-II, MADIT-RISK, MADIT-CRT, MADIT-RIT, RAID). The authors evaluated the association of device therapy with subsequent mortality in 4 separate time-dependent models: model I, type of ICD therapy; model II, type of arrhythmia for which ICD therapy was delivered; model III, combined assessment of all arrhythmia and therapy types during follow-up; and model IV, incremental risk associated with repeated ICD shocks. When analyzed by the type of ICD therapy (model I), a first appropriate ICD shock was associated with increased risk of subsequent mortality with or without concomitant occurrence of inappropriate shock during follow-up (hazard ratios [HRs]: 2.78 and 2.31; p < 0.001 and p = 0.12), whereas inappropriate shock alone was not associated with mortality risk (HR: 1.23; p = 0.42). Similarly, ICD therapy for ventricular tachycardia (VT) ≥200 beats/min or ventricular fibrillation (VF) (model II) was associated with increased risk of death with or without concomitant therapy for VT <200 beats/min (HRs: 2.25 and 2.62; both p < 0.001), whereas appropriate therapy for VT <200 beats/min or inappropriate therapy (regardless of etiology) did not reach statistical significance (all p > 0.10). Combined assessment of all therapy and arrhythmia types during follow-up (model III) showed that appropriate ICD shocks for VF, shocks for fast VT (≥200 beats/min) without prior antitachycardia pacing (ATP), as well as shocks for fast VT delivered after failed ATP, were associated with the highest risk of subsequent death (HRs: all >2.8; p < 0.001). Finally, 2 or more ICD appropriate shocks were not associated with incremental risk to the first appropriate ICD shock (model IV). The combined data from 5 landmark ICD trials suggest that the underlying arrhythmic substrate rather than the ICD therapy is the more important determinant of mortality in ICD recipients.
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DOI：
10.1056/nejmoa071098
发表时间：
2008-09-04
期刊：
The New England journal of medicine
影响因子：
--
作者：
Poole JE;Johnson GW;Hellkamp AS;Anderson J;Callans DJ;Raitt MH;Reddy RK;Marchlinski FE;Yee R;Guarnieri T;Talajic M;Wilber DJ;Fishbein DP;Packer DL;Mark DB;Lee KL;Bardy GH
通讯作者：
Bardy GH
影响因子：
158.5
作者：
Moss, Arthur J.;Hall, W. Jackson;Zareba, Wojciech
通讯作者：
Zareba, Wojciech
影响因子：
37.8
作者：
Moss, AJ;Greenberg, H;Elkin, AD
通讯作者：
Elkin, AD
影响因子：
24
作者：
Zareba, Wojciech;Daubert, James P.;Moss, Arthur J.
通讯作者：
Moss, Arthur J.
DOI：
10.1111/j.1540-8159.2011.03275.x
发表时间：
2012-03-01
影响因子：
1.8
作者：
Francis, Charles K.;Kuo, Yen-Hong;Daniels, Steven
通讯作者：
Daniels, Steven