植入左心室辅助装置患者术后发生室性心律失常的术前危险因素分析  

Predictors of postoperative ventricular arrhythmias in patients with continuous-flow left ventricular assist devices

作　　者：杜娟 陈晨 邹亮 陈伊 施野 王现强 胡盛寿[1] Du Juan;Chen Chen;Zou Liang;Chen Yi;Shi Ye;Wang Xianqiang;Hu Shengshou(Department of Surgery,Fuwai Hospital,Chinese Academy of Medical Sciences,Peking Union Medical College,National Center for Cardiovascular Disease,State Key Laboratory of Cardiovascular Disease,Beijing 100037,China)

机构地区：[1]国家心血管病中心,心血管疾病国家重点实验室,北京协和医学院,中国医学科学院,阜外医院成人外科中心,北京100037

出　　处：《中华心力衰竭和心肌病杂志（中英文）》2022年第2期112-119,共8页Chinese Journal of Heart Failure and Cardiomyopathy

基　　金：高水平医院临床科研项目(2022-GSP-QZ-7)。

摘　　要：目的旨在探究植入左心室辅助装置(LVAD)患者术后近远期发生室性心律失常(VAs)的术前独立危险因素。方法纳入2017年6月至2022年4月期间于中国医学科学院阜外医院行LVAD植入术的患者进行回顾性分析,单因素及多因素logistic回归分析影响患者术后近远期发生VAs的术前危险因素。术前及术后VAs均定义为持续>30s的室性心动过速或心室颤动并且需要植入型心律转复除颤器(ICD)治疗、体外电除颤或药物治疗。结果共有57例LVAD患者纳入分析,年龄(45.5±10.6)岁,男性51例(占89.5%),17例(占29.8%)植入液力悬浮离心泵,40例(占70.2%)植入全磁悬浮离心泵。无一例患者术后早期(术后30d内)死亡,术后有10例(占17.5%)发生VAs,其中,4例(占7.0%)发生在术后早期(术后30d内),均表现为电风暴(ES),其余6例(占10.5%)VAs发生在术后30d之后,无ES表现。多因素logistic回归分析结果显示,术前VAs病史[比值比(OR)16.734,95%可信区间(CI)1.959~142.923,P=0.010]及术前为心房颤动(OR 12.656,95%CI 1.263~126.772,P=0.031)是影响术后VAs发作的独立危险因素。术前VAs(ρ=0.554,P<0.01)比术前房颤(ρ=0.317,P=0.016)与术后VAs发作具有更强的相关性。术后早期发生ES的患者与未发生ES的患者基线资料比较,术前左心室舒张末期内径<70 mm(75.0%比20.8%,P=0.042),术中同期行冠状动脉旁路移植术(75.0%比18.9%,P=0.034)的比例更高,术前左心室射血分数[(18.3±4.1)%比(24.7±4.0)%,P=0.003]更低。结论VAs是LVAD植入术后近远期常见的并发症,术前存在心律失常(VAs及房颤)与术后VAs发作呈显著性相关,对这部分患者围术期应严密监测,减少LVAD术后VAs,尤其是术后早期ES发作的策略仍然需要进一步研究。Objective To identify the preoperative risk factors for postoperative ventricular arrhythmias(VAs)after implantation of left ventricular assist device(LVAD).Methods Patients underwent implantation of LVAD in the Fuwai Hospital,Chinese Academy of Medical Science from June 2017 to April 2022 were enrolled.Univariate and multivariate logistic regression analysis were used to identify the preoperative risk factors for postoperative VAs.Pre-and postoperative VAs were defined as ventricular tachycardia(VT)lasting more than 30 seconds or ventricular fibrillation(VF)and requiring effective termination by implantable cardioverter-defibrillators,external electrical shock or medical therapy.Results A total of 57 patients underwent LVAD implantation were included,with the age of(45.5±10.6)years and 51(89.5%)males,among whom 17(29.8%)were implanted with hydrodynamic levitation centrifugal pump and other 40(70.2%)were implanted with magnetic levitation centrifugal pump.Among these patients,10(17.5%)suffered from postoperative VAs,in which 4 cases(7.0%)were early VAs(<30 days post-LVAD)with electrical storm(ES),while the other 6 cases(10.5%)were late VAs(>30 days post-LVAD)without ES.Multivariate logistic regression analysis showed that history of VAs pre-LVAD[odds ratio(OR)16.734,95%(confidence intercal,CI)1.959-142.923,P=0.01)and preoperative atrial fibrillation(AF)(OR 12.656,95%CI 1.263-126.772,P=0.031)were the independent predictors of postoperative VAs.Furthermore,history of VAs(ρ=0.554,P<0.01)showed stronger correlation with postoperative VAs than AF(ρ=0.317,P=0.016).Compared to the those without ES early after LVAD,patients with early ES were more likely to have a preoperative left ventricular end-diastolic diameter(LVEDD)<70 mm(75.0%vs.20.8%,P=0.042),higher frequency of concurrent coronary artery bypass grafting(75.0%vs.18.9%,P=0.034)and lower preoperative left ventricular ejection fraction(LVEF)[(18.3±4.1)%vs.(24.7±4.0)%,P=0.003].Conclusion VAs are common complications after LVAD implantation.History of arrhythmia

关 键 词：左心室辅助装置 室性心律失常 电风暴 室性心动过速 心房颤动 

分 类 号：R541.7[医药卫生—心血管疾病]