The prognostic impact of shocks for clinical and induced arrhythmias on morbidity and mortality among patients with implantable cardioverter-defibrillators
The prognostic impact of shocks for clinical and induced arrhythmias on morbidity and mortality among patients with implantable cardioverter-defibrillators
复制标题
DOI：
10.1016/j.hrthm.2010.02.039
复制
发表时间：
2010-06-01
期刊：
影响因子：
5.5
通讯作者：
Clyne, Christopher A.
中科院分区：
文献类型：
--
作者：
Bhavnani, Sanjeev P.;Kluger, Jeffrey;Clyne, Christopher A.
背景最近的研究表明，植入式心律转复除颤器（ICD）电击的发生与不良的长期结局有关。这些研究强调，风险最合理的原因是心律失常，而不是电击本身。我们试图比较植入除颤阈值测试和无创电生理学研究（NIPS）的影响，诱导室性心律失常的电击输送对ICD患者的长期结局临床休克among patients with ICDs.METHODS这是一个队列评估的1,372例患者接受ICD植入在三级医院从1997年12月至2007年1月。使用多变量考克斯比例分析，基于ICD电击类型评价急性失代偿性心力衰竭（ADHF）的全因死亡率和住院率。所分析的四种电击类型是仅植入电击（n = 694）、仅附加NIPS电击（n = 319）、仅附加适当电击（n = 128）或仅附加不适当电击（n = 104）。NIPS电击接受者和植入性电击接受者之间的ADHF（校正的风险比[AHR] 0.91 [95%置信区间（CI）0.69-1.20]; P = 0.491）或ADHF（AHR 0.71 [95% CI 0.46-1.16]; P = 0.277）相似。接受适当的ICD电击会增加死亡风险（AHR 2.09 [95% CI 1.38-2.69]; P < .001）和ADHF（AHR 2.40 [95%CI 1.51-3.81]; P < .002），与植入性休克相比，（AHR 2.61 [95% CI 1.86-3.67]; P < .001）和ADHF（AHR 2.29 [95% CI 1.33-3.97]; P = .003）结论：与合适的ICD接受者相比，在NIPS测试时诱导室性心律失常期间递送ICD电击不会增加死亡或ADHF的风险震荡易受损基质中自发性心律失常的发生可以解释风险增加。
BACKGROUND Recent investigations have demonstrated that the occurrence of implantable cardioverter-defibrillator (ICD) shocks is associated with adverse long-term outcomes. These studies have emphasized that the risk is most reasonably due to arrhythmias rather than to the shock itself. We sought to compare the impact of shock delivery for induced ventricular arrhythmias during implantation defibrillation threshold testing and noninvasive electrophysiology study (NIPS) to clinical shocks on long-term outcomes among patients with ICDs.METHODS This was a cohort evaluation of 1,372 patients undergoing ICD implantation at a tertiary hospital from December 1997 to January 2007. The probability of all-cause mortality and hospitalization for acute decompensated heart failure (ADHF) was evaluated based upon the type of ICD shock received using multivariable Cox proportional analyses. The four shock types analyzed were implantation shocks only (n = 694), additional NIPS shocks only (n = 319), additional appropriate shocks only (n = 128), or additional inappropriate shocks only (n = 104).RESULTS The risk of death (adjusted hazard ratio [AHR] 0.91 [95% confidence interval (CI) 0.69-1.20]; P = .491) or ADHF (AHR 0.71 [95% CI 0.46-1.16]; P = .277) were similar between recipients of NIPS shocks and recipients of implantation shocks. Receiving an appropriate ICD shock increased the risk of death (AHR 2.09 [95% CI 1.38-2.69]; P < .001) and ADHF (AHR 2.40 [95% CI 1.51-3.81]; P < .002) as compared with implantation shocks and also increased the risk of death (AHR 2.61 [95% CI 1.86-3.67]; P < .001) and ADHF (AHR 2.29 [95% CI 1.33-3.97]; P = .003) as compared with NIPS shocks.CONCLUSIONS ICD shocks delivered during induced ventricular arrhythmias at the time of NIPS testing does not increase the risk of death or ADHF as compared with recipients of appropriate ICD shocks. The occurrence of spontaneous arrhythmias in vulnerable substrates may explain the increased risk.