心脏再同步化治疗后期阶段植入心脏复律除颤器的必要性

Necessity of Implanting Cardioverter Defibrillator in Late Stage of Cardiac Resynchronization Therapy

目的 探讨心脏复律除颤器(ICD)在心脏再同步化治疗有反应患者后期阶段预防性植入的必要性.方法 回顾性分析CRT-D/CRT植入前后超声随访记录,包括左房内径大小(LAD)、左室收缩末内径(LVESD)、左室舒张末期内径(LVEDD)、左室射血分数(LVEF);回顾CRT-D/CRT二者随访的心律失常发生情况及CRT-D放电治疗事件;二者5年生存率.结果(1)80例CRT/CRT-D植入后有反应的患者(CRT44例,CRT-D36例),平均随访时间(6±2.8)年,两组治疗有反应患者LAD、LVEDD、LVESD数值均较植入前缩小,左室射血分数(LVEF)较植入前升高,但两组治疗有反应患者心脏结构及射血分数在植入后4年与植入后1年的变化值比较差异无统计学意义(P>0.05);(2)CRT-D/CRT植入后?1年内均有新发心律失常事件,两组比较差异无统计学意义(P>0.05),随访4年后二者新发生恶性心律失常事件发生率较低;(3)CRT-D治疗组患者5年生存率为86.1%,CRT治疗组5年生存率为84.1%,两组比较差异无统计学意义(P=0.748).结论? CRT能改善部分心力衰竭患者心功能、逆转心室重构.随着治疗的持续,CRT能逐步减少有反应患者心律失常的发生,在治疗后期阶段可能不需预防性植入ICD.

Objective To compare the efficacy of CRT-D/CRT,and to investigate the necessity of implantable cardioverter defibrillator(ICD)in patients with reactions undergoing cardiac resynchronization therapy at the later stage.Methods Ultrasonic follow-up records before and after CRT-D/CRT implantation were retrospectively analyzed,including left atrial diameter(LAD),left ventricular end-systolic diameter(LVESD),left ventricular end-diastolic diameter(LVEDD)and left ventricular ejection fraction(LVEF).Arrhythmia events of CRT-D/CRT and discharge events of CRT-D in the cardiac pacemaker clinic and five-year survival rate of CRT-D/CRT were reviewed.Results(1)A total of 80 patients with reactions after CRT/CRT-D implantation(CRT,n=44;CRT-D,n=36)were included in this study from ShaoXing Hospital Affiliated to China Medical University and Huadong Hospital Affiliated to Fudan University.Mean follow-up time was 6±2.8 years.LAD,LVEDD and LVESD in patients with reactions in both treatment groups decreased when compared with those before implantation,while LVEF increased than that before implantation.No statistically significant differences were found in cardiac structure or ejection fraction in patients with reactions of both treatment groups at the 1st year and 4th year after implantation(P>0.05);(2)New arrhythmia events were detected after CRT-D/CRT implantation within 1 year,with no significantly statistical differences(P>0.05).After 4-year follow-up,the proportion of malignant arrhythmia events was extremely low;(3)Five-year survival rates in the CRT-D group and CRT group were 86.1%and 84.1%,respectively(P=0.334).Conclusion CRT can improve partial heart function and reverse ventricular remodeling in patients with heart failure.With continuous treatment,CRT can gradually reduce the occurrence of arrhythmia in patients with reactions,and in the later stage of treatment,prophylactic implantation of ICD may not be needed.