Looking Beyond Storm: Forecast Remains Gloomy for Clustered Ventricular Arrhythmias.
Looking Beyond Storm: Forecast Remains Gloomy for Clustered Ventricular Arrhythmias.
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展望风暴之外：丛集性室性心律失常的预测仍然悲观。
DOI：
10.1016/j.jacep.2019.12.014
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发表时间：
2020
期刊：
影响因子：
--
通讯作者：
Vaseghi,Marmar
中科院分区：
文献类型：
--
作者：
Khakpour,Houman;Vaseghi,Marmar
二十多年前，Fries et al. (1)创造了短语“短期复发性快速性心律失常”来描述电风暴，其被任意定义为由> 1小时的窦性心律分隔的$2室性心律失常（VA）事件。这些研究人员发现了与死亡率增加的相关性。从那时起，该术语经历了几次迭代;电或室性心动过速（VT）风暴现在通常定义为24小时内3美元的VA发作，需要植入式心律转复除颤器（ICD）治疗。几项研究表明，电风暴与不良结局独立相关，包括在一级和二级预防试验中死亡风险增加。在MADIT II（多中心自动除颤器植入试验II）试验中，与无任何VA的患者相比，电风暴患者前3个月死亡的风险比（HR）为17.8。HR在3个月后继续保持升高，平均随访约21个月期间HR为3.5（2）。此外，在AVID（抗癫痫药与植入式除颤器）试验中，电风暴是死亡的重要独立风险因素（风险比：2.4; p= 0.003）（3）。尽管多项后续研究（包括荟萃分析）证实了与电风暴相关的死亡风险增加（4，5），但对VA的最小负担或簇状VA的持续时间及其与结局的相关性知之甚少。在24小时内超过3次ICD治疗后，是否有特定数量的事件或发生VA的时间长度可预测死亡风险增加？在这一期的JACC：临床电生理学，Elsokkari等人。(6)调查了这个问题。在一项精心设计的回顾性研究中，使用来自RAFT（动态心力衰竭再灌注试验）的器械信息，这些研究者评价了VA负荷和聚集性对死亡率的影响。RAFT研究包括左心室射血分数<30%和纽约心脏协会功能分级为II或III级心力衰竭的患者，这些患者有ICD植入的主要或次要适应症; 69%的RAFT研究人群患有缺血性心脏病。研究者将VA发作定义为ICD检测到的持续VA事件。对所有VA进行裁定，以确保适当检测。共有1，764名患者入选该研究。组被定义为具有非聚集性VA（1起总VA事件或2起事件间隔> 3个月; n= 406）或聚集性VA（3个月内至少发生2次VA发作; n= 465）。将这些组与随访期间没有VA发作的对照组进行比较。中位随访时间约为40个月。为了更密切地比较群集VA组，分析了固定时间段内2、3、4 - 9和10美元VA发作的预定群集心律失常负荷，以及1、3、7、30和90天的群集期长度。这两种影响
More than 2 decades ago, Fries et al.(1) coined the phrase “short-term recurrent tachyarrhythmias” to describe an electrical storm, which was arbitrarily defined as $2 ventricular arrhythmia (VA) events separated by> 1 h of sinus rhythm. These investigators found an association with increased mortality. Since then, the term has undergone several iterations; electrical or ventricular tachycardia (VT) storm is now commonly defined as $3 episodes of VA within a 24-h period that requires implantable cardioverter-defibrillator (ICD) therapy. Several studies have shown an electrical storm to be independently associated with adverse outcomes, including an increased risk of mortality in both primary and secondary prevention trials. In the MADIT II (Multicenter Automatic Defibrillator Implantation Trial II) trial, the hazard ratio (HR) for death in the first 3 months was 17.8 in patients with electrical storm compared with patients without any VAs. The HR continued to remain elevated beyond the 3-month period, with an HR of 3.5 during the average follow-up of approximately 21 months (2). In addition, in the AVID (Antiarrhythmics Versus Implantable Defibrillators) trial, an electrical storm was a significant independent risk factor for death (risk ratio: 2.4; p= 0.003)(3). Although multiple subsequent studies, including a meta-analysis, confirmed the increased risk of death associated with an electrical storm (4, 5), little is known about the minimum burden of VA or duration of clustered VAs and their association with outcomes. Beyond 3 ICD therapies in a 24-h period, is there a particular number of events or a length of time during which VAs occur that would predict an increased risk of death?In this issue of JACC: Clinical Electrophysiology, Elsokkari et al.(6) investigated this question. In a thoughtfully designed retrospective study using device information from the RAFT (Resynchronization in Ambulatory Heart Failure Trial), these investigators evaluated the impact of VA burden and clustering on mortality. The RAFT study included patients with left ventricular ejection fractions of# 30% and in New York Heart Association functional classes II or III heart failure, who had either a primary or secondary indication for ICD implantation; 69% of the RAFT study population had ischemic heart disease. The investigators defined a VA episode as an event detected by ICD as sustained VAs. All VAs were adjudicated to assure appropriate detection. A total of 1,764 patients were included in the study. Groups were defined as having unclustered VAs (1 total VA event or $2 events> 3 months apart; n= 406) or clustered VAs (with at least 2 VA episodes that occurred within a 3-month period; n= 465). These groups were compared against a control group that had no VA episodes during follow-up. The median follow-up was approximately 40 months. To allow for a closer comparison of the clustered VA group, pre-specified cluster arrhythmia burdens of 2, 3, 4 to 9, and $10 VA episodes during a fixed period of time, as well as cluster period lengths of 1, 3, 7, 30, and 90 days, were analyzed. Both the effects
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影响因子：
5.5
作者：
Tung R;Vaseghi M;Frankel DS;Vergara P;Di Biase L;Nagashima K;Yu R;Vangala S;Tseng CH;Choi EK;Khurshid S;Patel M;Mathuria N;Nakahara S;Tzou WS;Sauer WH;Vakil K;Tedrow U;Burkhardt JD;Tholakanahalli VN;Saliaris A;Dickfeld T;Weiss JP;Bunch TJ;Reddy M;Kanmanthareddy A;Callans DJ;Lakkireddy D;Natale A;Marchlinski F;Stevenson WG;Della Bella P;Shivkumar K
通讯作者：
Shivkumar K
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
延长植入式心脏复律除颤器心律失常检测时间对结果的影响：荟萃分析。
影响因子：
5.5
作者：
P. Scott;J. Silberbauer;T. McDonagh;F. Murgatroyd
通讯作者：
F. Murgatroyd
在植入式除颤器治疗时代，电风暴是不良长期结果的独立预测因素。
影响因子：
6.1
作者：
K. Gatzoulis;G. Andrikopoulos;T. Apostolopoulos;E. Sotiropoulos;G. Zervopoulos;J. Antoniou;S. Brili;C. Stefanadis
通讯作者：
C. Stefanadis