Implantable defibrillators for secondary prevention of sudden cardiac death in cardiac surgery patients with perioperative ventricular arrhythmias.
Implantable defibrillators for secondary prevention of sudden cardiac death in cardiac surgery patients with perioperative ventricular arrhythmias.
复制标题
可植入的除颤器可用于预防心脏手术室心律不齐的心脏手术患者心脏猝死。
DOI：
10.1161/jaha.113.000686
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发表时间：
2014-08-21
影响因子：
5.4
通讯作者：
Yao JF
中科院分区：
文献类型：
--
作者：
Nageh MF;Kim JJ;Chen LH;Yao JF
植入式心律转复除颤器（ICD）的随机研究排除了在心脏事件之前或之后进行血运重建的心脏性猝死幸存者。为了评价ICD的作用和包括血运重建程度在内的临床变量的影响，我们研究了因围手术期持续性室性心律失常而植入ICD的心脏手术患者。在南加州Kaiser基金会医院的电子数据库中检索1999年至2005年期间接受心脏手术并在手术后3个月内植入ICD的患者。确定了164例患者; 93/164例患者因持续性术前或术后室性心动过速或需要复苏的室颤植入ICD。对以下记录进行了审查：心律失常、射血分数和血运重建程度。主要终点是总死亡率（TM）和/或适当的ICD治疗（ICD‐T），次要终点是TM和ICD‐T。在平均49个月的随访期间，分别在52例（56%）、35例（38%）和28例（30%）患者中观察到TM+ICD-T的主要终点以及TM和ICD-T的个体终点，其中55%的TM和23%的ICD-T发生在植入后2年内。在多变量风险分析中，以下各项均与任何终点无关：不完全血运重建、出现室性心律失常和心律失常的时间。我们的数据支持ICD在该患者队列中的最新指南，因为即使完全血运重建，也不能可靠地排除不可逆基质和室性心律失常的触发因素。需要进一步的研究来了解这一复杂的患者群体。
Randomized studies of implantable cardioverter defibrillators (ICD) have excluded sudden cardiac death survivors who had revascularization before or after an arrhythmic event. To evaluate the role of ICD and the effects of clinical variables including degree of revascularization, we studied cardiac surgery patients who had an ICD implanted for sustained perioperative ventricular arrhythmias. The electronic database for Southern California Kaiser Foundation hospitals was searched for patients who had cardiac surgery between 1999 and 2005 and an ICD implanted within 3 months of surgery. One hundred sixty‐four patients were identified; 93/164 had an ICD for sustained pre‐ or postoperative ventricular tachycardia or fibrillation requiring resuscitation. Records were reviewed for the following: presenting arrhythmia, ejection fraction, and degree of revascularization. The primary end point was total mortality (TM) and/or appropriate ICD therapy (ICD‐T), and secondary end points are TM and ICD‐T. During the mean follow up of 49 months, the primary endpoint of TM+ICD‐T and individual end points of TM and ICD‐T were observed in 52 (56%), 35 (38%), and 28 (30%) patients, respectively, with 55% of TM, and 23% of ICD‐T occurring within 2 years of implant. In multivariate risk analysis, none of the following was associated with any of the end points: incomplete revascularization, presenting ventricular arrhythmia, and timing of arrhythmias. Our data supports the recent guidelines for ICD in this cohort of patients, as the presence of irreversible substrate and triggers of ventricular arrhythmias, cannot be reliably excluded even with complete revascularization. Further studies are needed to understand this complex group of patients.