Value of programmed ventricular stimulation after tetralogy of Fallot repair -: A multicenter study
Value of programmed ventricular stimulation after tetralogy of Fallot repair -: A multicenter study
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DOI：
10.1161/01.cir.0000126495.11040.bd
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发表时间：
2004-04-27
期刊：
影响因子：
37.8
通讯作者：
Walsh, EP
中科院分区：
文献类型：
--
作者：
Khairy, P;Landzberg, MJ;Walsh, EP
背景-研究一致表明，室性心动过速（VT）和心源性猝死（SCD）使法洛四联症修复术后的长期结局复杂化，方法和结果：一个多中心队列，252例法洛四联症修复患者接受程序心室刺激，随访18.5 +/-矫正手术和电生理测试后分别为9.6年和6.5 +/- 4.5年。临床VT和/或SCD发生率为24.6%。持续性单形性VT和多形性VT分别占30.2%和4.4%。将多态性室性心动过速纳入诱导性心动过速的定义提高了敏感性（66.1 +/- 6.0% vs 77.4 +/-5.3%，P = 0.0082），特异性略有降低（81.6 +/- 2.8% vs 79.5 +/-2.9%，P = 0.0455）。阳性和阴性预测值分别为55.2 +/- 5.3%和91.5 +/-2.2%。诱导的独立危险因素为研究时年龄≥ 18岁（OR，3.3）、心悸（OR，2.8）、既往姑息手术（OR，3.1）、改良Lown标准≥ 2（OR，5.6）和心胸比率≥ 0.6（OR，3.3）。不可诱导组和诱导组1、5、10和15年无事件生存率分别为97.9%、92.8%、89.3%和89.3%，而诱导组分别为79.4%、62.6%、58.7%和50.3%（P
Background-Studies have consistently shown that ventricular tachycardia (VT) and sudden cardiac death (SCD) complicate the long-term outcome after tetralogy of Fallot repair, yet the diagnostic and predictive value of electrophysiological testing in this population is uncertain.Methods and Results-A multicenter cohort of 252 patients with repaired tetralogy of Fallot undergoing programmed ventricular stimulation was followed up for 18.5 +/- 9.6 and 6.5 +/- 4.5 years after corrective surgery and electrophysiological testing, respectively. Clinical VT and/or SCD occurred in 24.6%. Sustained monomorphic VT and polymorphic VT were induced in 30.2% and 4.4%. Including polymorphic VT in the definition of inducibility improved sensitivity (66.1 +/- 6.0% versus 77.4 +/- 5.3%, P = 0.0082) with a marginal reduction in specificity (81.6 +/- 2.8% versus 79.5 +/- 2.9%, P = 0.0455). Positive and negative predictive values were 55.2 +/- 5.3% and 91.5 +/- 2.2%. Independent risk factors for inducibility were age at study greater than or equal to18 years (OR, 3.3), palpitations (OR, 2.8), prior palliative surgery (OR, 3.1), modified Lown criteria greater than or equal to2 (OR, 5.6), and cardiothoracic ratio greater than or equal to0.6 (OR, 3.3). Event-free survival rates in noninducible and inducible patients at 1, 5, 10, and 15 years were 97.9%, 92.8%, 89.3%, and 89.3% versus 79.4%, 62.6%, 58.7%, and 50.3%, respectively (P