埋藏式心律转复除颤器植入后电风暴再发发生率和相关危险因素分析

Prevalence and related risk factors of electrical storm recurrence in patients with implantable cardioverter-defibrillators

目的：研究本心脏中心埋藏式心律转复除颤器（ICD）植入后电风暴再发的相关危险因素。方法回顾性研究分析和比较因I级预防和II级预防接受ICD治疗的患者的基础疾病特征、室性心律失常、电风暴事件及电风暴再发的相关危险因素。结果共植入ICD 231例，随访（30.2±23.5）个月。I级预防98例，II级预防133例。室性心动过速/心室颤动发生率22.9%（53/231）；其中I级预防组中发生率7.1%（7/98），显著低于II级预防组34.6%（46/133）（P＜0.01）。共20例（8.7%）发生电风暴，发生在II级预防组中19例（14.3%），12例（60.0%）经历≥2次电风暴事件，即电风暴再发。83.3%（10/12）电风暴再发者在第1次事件后的1年内再发电风暴。左心室射血分数30％~40％（OR 4.861，95%CI 1.483~15.932，P＜0.01）和II级预防患者（OR 10.211，95%CI 1.304~79.942，P＜0.01）是电风暴再发的相关危险因素。结论电风暴在ICD患者群中的发生率并不少见，电风暴再发多见于初发后1年内。明显左心室收缩功能不全和II级预防者电风暴再发危险性增大。

Objective To determine the prevalence and related risk factors of electrical storm recurrence in patients with implantable cardioverter- defibril ator （ICD） in our heart centre. Methods Clinical features, ventricular arrhythmia, electrical storm events and the risk factors related to electrical storm recurrence were retrospectively analyzed in patients underwent ICD implantation for primary and secondary prevention during 2004- 2013. Results A total of 231 cases （98 cases for primary prevention , 133 cases for secondary prevention） were implanted with ICD and fol owed up for 30.2 ± 23.5 months. Ventricular tachycardia/ventricular fibrillation occurred in 53 cases （22.9%）. Of them, 7 cases （7.1%） was in primary prevention group, significantly lower than 46 cases （34.6%） in secondary prevention group （P〈0.01）. Electrical storm oc-curred in 20 cases （8.7%） with majority in secondary prevention group（19/133 cases）. 12 cases（60.0%） experienced≥2 electrical storm events, of them, 10 cases （83.3%） had electrical storm recurrence within a year. Left ventricular ejection frac-tion of 30%to 40% （OR 4.861, 95%CI 1.483~15.932, P〈0.01） and secondary prevention （OR 10.211, 95%CI 1.304~79.942, P〈0.01） were related risk factors for electrical storm recurrence. Conclusion Electrical storm is not uncommon in ICD pa-tients and recurs mostly within one year after first attack and in patients with severe left ventricular systolic dysfunction and with an ICD implanted for secondary prevention.