植入埋藏式心脏转复除颤器患者室性心律失常发生的多因素分析  

Multivariable analysis of incident ventricular tachycardia or ventricular fibrillation in patients with implantable cardioverter defibrillator

作　　者：陆秋芬[1] 孙健[1] 王君[1] 张澎湃[1] 李毅刚[1] LU Qiu-fen;SUN Jian;WANG J un;ZHANG Peng-pai;LI Yi-gang(Department of Cardiology, Xinhua Hospital, Shanghai Jiao Tong University, Shanghai 200092, Chin)

机构地区：[1]上海交通大学医学院附属新华医院心血管内科,上海200092

出　　处：《中国心脏起搏与心电生理杂志》2018年第1期49-52,共4页Chinese Journal of Cardiac Pacing and Electrophysiology

摘　　要：目的探讨植入埋藏式心脏转复除颤器(ICD)患者术后发生室性心动过速/心室颤动(简称室速/室颤)的危险因素。方法回顾分析植入ICD/心脏再同步化治疗除颤(CRTD)的患者51例,随访(39.4±22.3)个月,19例ICD/CRTD记录到持续性室速和或快室速、室颤,为室性心律失常组;32例ICD/CRTD未记录到持续性室速和或快室速、室颤事件,为非室性心律失常组。分析ICD/CRTD植入患者发生室性心律失常的临床因素以及两组患者临床事件的发生情况,并作logistic回归分析。结果对51例ICD/CRTD植入患者月随访中,发现有19例(37.3%)ICD/CRTD记录到室速/快室速/室颤,而且ICD/CRTD给予恰当治疗(ATP或电击),其中3例经历了室速电风暴。对ICD/CRTD植入患者术后室性心律失常和临床事件发生作多因素分析发现,室性心律失常的发生与术后12个月的左室射血分数(LVEF)值显著相关(r=0.149,P=0.047),ICD/CRTD术后住院/死亡的发生与缺血性心肌病(r=17.643,P=0.045)、可达龙(r=14.672,P=0.013)、室性心律失常(r=21.561,P=0.046)显著相关。结论术后12个月LVEF值的显著提高可减少室性心律失常的发生。缺血性心肌病及术后室性心律失常的发生会增加ICD/CRTD植入患者术后住院/死亡的发生,而可达龙可有效降低住院/死亡率。Objective To investigate risk factors of incident ventricular tachycardia or ventricular fibrillation in pa- tients after implantation of implantable cardioverter defibrillators （ICDs）. Methods A total of 51 patients with ICD with or without concomitant cardiac resynchronization therapy were retrospectively analyzed. During a follow-up of 24 to 88 months, patients were divided into ventricular arrhytbmia group （with detected ventricular arrhythmia during the follow-up, n = 19） and non-ventricular arrhythmia group （without detected ventricular arrbythmia during the follow-up, n=32）. Clinical incident and risk factors associated with ventricular arrhythmia were analyzed and further logistic regression analysis was done. Results After a mean follow-up of （39.4±22.3） months, ventricular arrhythmia was detected in 19 （37.3%） patients, with 3 of whom suffered electrical storms, and all of them were treated appropriately （ATP or shocking）. Multivariable analysis showed that the incident ventricular arrhythmia was significantly associated with ejection fraction measured 12 months after implantation （r=0.149,P =0.047）. In addition, hospital readmission rate and mortality rate after implantation were significantly associated with ischemic cardiomyopathy （r= 17.643 ,P =0.045）, use of amiodarone （r= 14.672 ,P =0.013） and incident ventricular arrhythmia （r=21.561,P=0.046）. Conclusion The increase of ejection fraction 12 months after implantation of ICD/ CRTD is associated with the decrease of incident ventricular arrhythmia. Moreover, ischemic cardiomyopathy and incident ventricular arrhythrnia increases hospital readmission rate and mortality rate after implantation of ICD/ CRTD, while the use of amiodarone decreases it.

关 键 词：心血管病学 埋藏式心脏转复除颤器 室性心律失常 预测因素 

分 类 号：R541.7[医药卫生—心血管疾病] R318.11[医药卫生—内科学]