Arrhythmic death in implantable cardioverter defibrillator patients: a long-term study over a 10 year implantation period
Arrhythmic death in implantable cardioverter defibrillator patients: a long-term study over a 10 year implantation period
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DOI：
10.1093/europace/eup246
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发表时间：
2009-11-01
期刊：
影响因子：
6.1
通讯作者：
Hohnloser, Stefan H.
中科院分区：
文献类型：
--
作者：
Duray, Gabor Z.;Schmitt, Joern;Hohnloser, Stefan H.
在一个大的队列研究中，对连续植入心脏复律除颤器（ICD）的患者进行死因特异性死亡率的评估，对连续植入10年以上的ICD患者的死因进行分析。总共对822名患者（年龄63 +/- 11岁，80%男性，EF 34 +/-14%，二级预防65%）进行了43 +/- 30个月的随访，期间有225名患者死亡（年死亡率7.6%）。死亡原因为心源性心脏病16%，心源性非心脏病39%，非心血管性4%，非心血管性27%，未知13%。高龄[相对风险（RR）1.23/10年，95%置信区间（CI）1.06-1.43]，NYHA分级> II级（RR 2.27，95% CI 1.51-3.41），肾衰竭（RR 1.57，95% CI 1.15-2.14），使用胺碘酮（RR 2.56，95% CI 1.91-3.43）、洋地黄（RR 1.87，95% CI 1.40-2.49）、利尿剂（RR 1.89，95% CI 1.35-2.66）是全因死亡的独立预测因子。心脏病死亡的预测因子为NYHA心功能分级> II级（RR 12，95% CI 3.69-37.5），自发性或诱导性VT作为ICD治疗的适应症（RR 2.53，95% CI 1.06-6.05）和胺碘酮的使用（RR 3.95，95% CI 2.02-7.75）。在这组ICD接受者中，至少有16%的患者死于药物原因。与心脏病死亡率相关的风险因素是自发性或诱导性室性心动过速病史、较高的NYHA分级和胺碘酮使用。
Evaluation of cause-specific mortality in a large cohort of unselected implantable cardioverter defibrillator (ICD) recipients.Causes of death of consecutive ICD recipients implanted over a 10 year period were analysed. Overall 822 patients (age 63 +/- 11 years, 80% male, EF 34 +/- 14%, secondary prevention 65%) were followed for 43 +/- 30 months during which time 225 patients died (annual mortality 7.6%). Causes of death were cardiac arrhythmic in 16%, cardiac non-arrhythmic in 39%, non-cardiac vascular in 4%, non-cardiovascular in 27%, and unknown in 13%. Advanced age [relative risk (RR) 1.23 per decades, 95% confidence interval (CI) 1.06-1.43], NYHA class > II (RR 2.27, 95% CI 1.51-3.41), renal failure (RR 1.57, 95% CI 1.15-2.14), use of amiodarone (RR 2.56, 95% CI 1.91-3.43), digitalis (RR 1.87, 95% CI 1.40-2.49), diuretics (RR 1.89, 95% CI 1.35-2.66) were independent predictors of all-cause mortality. Predictors for arrhythmic mortality were NYHA class > II (RR 12, 95% CI 3.69-37.5), spontaneous or inducible VT as indication for ICD therapy (RR 2.53, 95% CI 1.06-6.05), and use of amiodarone (RR 3.95, 95% CI 2.02-7.75).In this unselected group of ICD recipients, at least 16% of patients died from arrhythmic causes. Risk factors associated with arrhythmic mortality were a history of spontaneous or inducible VT, higher NYHA class, and amiodarone use.