心脏性猝死一级预防与二级预防患者植入埋藏式心脏转复除颤器术后的随访观察

A comparative study of survival and appropriate therapy between patients of cardioverter defibrillator implantation for primary and secondary prevention of sudden cardiac death

目的对比心脏性猝死(SCD)一级和二级预防患者植入埋藏式心脏转复除颤器(ICD)术后生存与适当治疗的情况。方法连续入选于本院行ICD或带除颤功能的心脏再同步治疗(CRT-D)植入术的患者,随访记录患者的生存情况、ICD保存的室性心律失常与治疗数据,对比一级预防与二级预防组间生存与ICD适当治疗,并寻找ICD术后生存和ICD适当治疗的预测因素。结果入选124例患者,一级预防组63例,二级预防组61例,中位随访时间300天。共有12例患者死亡(9.6%),其中一级预防组7例(11.1%),二级预防组5例(8.2%),组间生存曲线无统计学差异(P=0.095)。术前log(NT-proBNP)是术后生存的唯一独立预测因素(HR=8.81,P=0.047)。共有24例患者接受过ICD适当治疗(19.4%),组间术后ICD适当治疗曲线存在显著差异(P=0.014)。QRS波时限(QRSd)是术后ICD适当治疗的独立预测因素(HR=1.24,P=0.020)。QRSd≥120 ms的患者中二级预防组患者更早接受ICD适当治疗(P=0.027),QRSd<120 ms的患者中组间首次ICD适当治疗时间无差异(P=0.242)。结论因SCD一级预防与二级预防植入ICD患者在术后生存无显著差异;二级预防较一级预防患者更早接受ICD适当治疗,这种差异主要归因于术前QRSd≥120 ms的患者。

Objective To compare survival and appropriate therapy between patients undergoing cardioverter defibrilla- tor implantation for primary and secondary prevention of sudden cardiac death （SCD）. Methods Patients undergoing implantation of implanted cardioverter defibrillator （ICD） or cardiac resynchronization therapy with defibrillator function （CRT-D） were consecutively recruited, and were divided into two groups based on the prevention of SCD. Survival and ap- propriate therapy were recorded and compared between groups, with assessment of predictors of survival and appropriate therapy after ICD implantation. Results A total numbers of 124 patients were enrolled, including 63 for primary and 61 for secondary prevention. There was no significant difference in survival curve （P = 0.095） between the two groups. More patients of secondary prevention received appropriate therapies （7.9% vs 31.2%, P 〈 0.01 ）, and there was significant difference in appropriate therapy curve between the two groups （P = 0. 014）. NT-proBNP level was the only predictor of survival（HR = 8.81, P = 0. 047 ） and QRSd for appropriate therapy after ICD implantation （ HR = 1.24, P = 0. 020） re- spectively. Patients of secondary prevention received earlier appropriate therapy in the subgroup of QRS duration （QRSd） ≥ 120 ms（P = 0.027）, while there was no difference in the subgroup of QRSd 〈 120 ms（P = 0.242）. ConclusionsThere is no difference in survival between patients of card- ioverter defibrillator implantation for primary and secondary prevention of SCD; patients treated for secondary preven- tion receive earlier appropriate therapy, which is more contributed by patients with QRSd ≥ 120 ms before implan- tation.