Implantable cardioverter-defibrillator explantation for overdiagnosed or overtreated congenital long QT syndrome
Implantable cardioverter-defibrillator explantation for overdiagnosed or overtreated congenital long QT syndrome
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DOI：
10.1016/j.hrthm.2015.12.008
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发表时间：
2016-04-01
期刊：
影响因子：
5.5
通讯作者：
Ackerman, Michael J.
中科院分区：
文献类型：
--
作者：
Gaba, Prakriti;Bos, J. Martijn;Ackerman, Michael J.
背景：目前长QT综合征（LOTS）的主要治疗包括β受体阻滞剂治疗，尽管植入式心律转复除颤器（ICD）被认为是高危患者。然而，过度诊断和过度治疗，必须避免，因为他们的后遗症可能是显着的。目的本研究的目的是评估的患病率和细节的ICD外植体在一个队列中的患者从第三遗传性心脏节律诊所以前提供的诊断LOTS.METHODS总体上，1227连续患者被列入研究。所有患者均被转诊至马约诊所，以评估可能的LOTS，随后被诊断为LOTS或被视为正常。对患者进行进一步分层，以评估有多少患者植入了ICD，有多少患者随后植入了ICD explant.Results，共有170例患者（14%）植入了ICD，包括670例患者中的157例（23%）确诊为LOTS，557例患者中的13例（2%）未植入LOTS。其中，12/1227例（1%）患者取出ICD：7/157例LOTS患者（4.5%）和5/14例非LOTS患者（36%）。在取出前，12例患者中有5例（42%）经历了不适当的电击，范围从2次到多达54次电击。此外，4例发生器械相关感染，9例发生器械故障（包括电极导线功能障碍或断裂）。这些患者中没有一个突破性的心脏事件，因为去除他们的ICD在5.5 +/- 3.5 years的following.CONCLUSION过度诊断和过度治疗的影响是深远的，因为不必要的ICD放置可能与感染，故障，不适当的冲击，和随后的焦虑。
BACKGROUND Primary treatment of long QT syndrome (LOTS) currently consists of beta-blocker therapy, although an implantable cardioverter-defibrillator (ICD) is considered for high-risk patients. However, both overdiagnosis and overtreatment must be avoided because their sequelae can be significant.OBJECTIVE The purpose of this study was to evaluate the prevalence and details of ICD explants in a cohort of patients from a tertiary genetic heart rhythm clinic for a previously rendered diagnosis of LOTS.METHODS Overall, 1227 consecutive patients were included in the study. All patients had been referred to the Mayo Clinic for evaluation of possible LOTS and subsequently were either diagnosed with LOTS or dismissed as normal. Further stratification of patients was conducted to assess how many patients had an ICD and how many had a subsequent ICD explant.RESULTS In total, 170 patients (14%) had an ICD, including 157 of 670 patients (23%) with confirmed LOTS and 13 of 557 patients (2%) who did not have LOTS. Among these, 12 of 1227 (1%) had the ICD removed: 7 of 157 LOTS patients (4.5%) compared to 5 of 14 non-LOTS patients (36%). Before explant, 5 of 12 patients (42%) experienced inappropriate shocks, ranging from 2 to as many as 54 shocks. In addition, 4 had a device-related infection, and 9 had device malfunction (including lead dysfunction or fracture). None of these patients had a breakthrough cardiac event since removal of their ICD during 5.5 +/- 3.5 years of follow-up.CONCLUSION Implications of overdiagnosis and overtreatment are profound because unnecessary ICD placement can be associated with infection, malfunction, inappropriate shocks, and subsequent anxiety.