Follow-up of patients with unexplained syncope and inducible ventricular tachyarrhythmias: analysis of the AVID registry and an AVID substudy. Antiarrhythmics Versus Implantable Defibrillators.
Follow-up of patients with unexplained syncope and inducible ventricular tachyarrhythmias: analysis of the AVID registry and an AVID substudy. Antiarrhythmics Versus Implantable Defibrillators.
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不明原因晕厥和诱发性室性快速心律失常患者的随访：AVID 登记和 AVID 子研究的分析。
DOI：
10.1046/j.1540-8167.2001.00996.x
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发表时间：
2001
影响因子：
2.7
通讯作者：
Hallstrom,A
中科院分区：
文献类型：
--
作者：
Steinberg,JS;Beckman,K;Greene,HL;Marinchak,R;Klein,RC;Greer,SG;Ehlert,F;Foster,P;Menchavez,E;Raitt,M;Wathen,MS;Morris,M;Hallstrom,A
AVID中的不明原因晕厥。简介：在抗心律失常药物与植入式除颤器（AVID）研究中进行了一项前瞻性登记研究和子研究，以阐明预后和复发事件率、风险因素以及植入式心律转复除颤器（ICD）治疗对不明原因晕厥、结构性心脏病和可诱导室性快速性心律失常患者的影响。方法和结果：AVID登记研究中包括来自所有参与中心的“院外晕厥伴结构性心脏病和EP诱导的VT/VF有症状”的患者。此外，作为正式前瞻性子研究的一部分，13家合作研究中心提供了更深入的临床和电生理数据。当地研究者对子研究中的患者进行了复发性腹泻事件和死亡率随访。通过国家死亡指数跟踪登记患者的致死性结局。共有429例晕厥患者进入AVID登记研究，其中80例参与了子研究。在子研究患者中，21例患者（26%）有可诱导的多形室性心动过速/室颤（VT/VF），11例患者（14%）有持续的单形心跳/分钟，48例患者（60%）出现持续单形搏动/min。ICD在75%的晕厥子研究患者中用作唯一治疗（另外9%的患者使用抗心律失常药物）和59%的晕厥登记患者。子研究患者的1年和3年生存率分别为93%和74%，登记研究患者的1年和3年生存率分别为90%和74%。在随机主试验中，晕厥子研究患者（主要接受ICD治疗）的生存率与接受ICD治疗的VT患者相似，但上级优于接受抗心律失常药物治疗的VT患者（）。子研究中的死亡事件可通过射血分数（）进行边缘预测，但不能通过电生理研究诱发的心律失常进行预测。在登记研究中，死亡率增加的显著预测因素是年龄（），死亡率降低的预测因素是ICD治疗（）。结论：这些分析的结果支持ICD作为不明原因晕厥、结构性心脏病和电生理检查中可诱导VT/VF患者的主要抗心律失常治疗的作用。
Unexplained Syncope in AVID.Introduction:A prospective registry and substudy were conducted in the Antiarrhythmics Versus Implantable Defibrillators (AVID) Study to clarify the prognosis and recurrent event rate, risk factors, and impact of implantable cardioverter defibrillator (ICD) therapy in patients with unexplained syncope, structural heart disease, and inducible ventricular tachyarrhythmias.Methods and Results:Included in the AVID registry were patients from all participating sites who had “out of hospital syncope with structural heart disease and EP‐inducible VT/VF with symptoms.” In addition, 13 collaborating sites provided more in‐depth clinical and electrophysiologic data as part of a formal prospective substudy. Patients in the substudy were followed by local investigators for recurrent arrhythmic events and mortality. Registry patients were tracked for fatal outcomes by the National Death Index. A total of 429 patients with syncope were entered in the AVID registry, of whom 80 participated in the substudy. Of the substudy patients, 21 patients (26%) had inducible polymorphic ventricular tachycardia/ventricular fibrillation (VT/VF), 11 patients (14%) had sustained monomorphicbeats/min, and 48 patients (60%) had sustained monomorphicbeats/min. The ICD was used as sole therapy in 75% of the syncope substudy patients (and with antiarrhythmic drug in an additional 9%) and in 59% of the syncope registry patients. Survival rates at 1 and 3 years were 93% and 74% for the substudy patients and 90% and 74% for the registry patients, respectively. Survival of the syncope substudy patients (predominantly treated by ICD) was similar to the VT patients treated by ICD and superior to the VT patients treated by an antiarrhythmic drug () in the randomized main trial. Mortality events in the substudy were marginally predicted by ejection fraction () but not by electrophysiologic study‐induced arrhythmia. The significant predictor of increased mortality in the registry was age () and of reduced mortality was treatment with ICD ().Conclusion:The results of these analyses support the role of the ICD as primary antiarrhythmic therapy in patients with unexplained syncope, structural heart disease, and inducible VT/VF at electrophysiologic study.