埋藏式心脏复律除颤器在肥厚型心肌病心脏性猝死高危患者一级预防中的临床疗效分析

Clinical Outcomes of Primary Prevention Implantable Cardioverter Defibrillator Therapy for Patients With Hypertrophic Cardiomyopathy

目的:总结分析国内肥厚型心肌病(HCM)心脏性猝死(SCD)高危患者一级预防植入埋藏式心脏复律除颤器(ICD)的有效性和安全性。方法:连续入选2011年1月至2017年12月在阜外医院植入ICD作为一级预防的HCM SCD高危患者,对ICD恰当治疗、不恰当治疗及ICD植入相关并发症进行回顾性分析。结果:共纳入38例HCM SCD高危患者,平均年龄(52.1±16.3)岁,其中男性25例(65.8%)。平均随访(29.3±24.2)个月,14例(36.8%)患者接受≥1次的ICD恰当治疗,ICD恰当治疗率为13.3%/年。多因素COX回归分析显示,SCD家族史(HR=11.8,95%CI:1.3～107.5,P=0.029)为ICD恰当治疗的独立预测因子。随访期间4例(10.5%)患者接受ICD不恰当治疗。2例(5.3%)患者发生ICD植入相关并发症,随访期间无死亡事件发生。结论:HCM SCD高危患者一级预防植入ICD恰当治疗率高,ICD不恰当治疗率和植入相关并发症发生率低,SCD家族史是ICD恰当治疗的独立预测因子。

Objectives: To analyze the efficacy and safety of primary prevention implantable cardioverter defibrillators(ICD) for sudden cardiac death(SCD) in patients with hypertrophic cardiomyopathy(HCM).Methods: Clinical data of HCM patients who received primary prevention ICDs in Fuwai Hospital from January 2011 to December 2017 were retrospectively analyzed. Results: Thirty-eight consecutive patients(mean age:[52.1±16.3] years, 25 males [65.8%]) were included in this study. and the average ICD implanted age was(2.1±16.3) years. Over a mean follow-up period of(29.3±24.2) months, ICD provided appropriate therapy in 14 patients(36.8%), the appropriate ICD therapy rate was 13.3%/year. Multiple Cox regression analysis showed that family history of SCD(HR=11.8, 95%CI: 1.3-107.5, P=0.029) was the independent predictor for appropriate therapy. Inappropriate therapy occurred in 4 patients(10.5%). Two patients(5.3%) experienced complications associated with ICD implantation. There was no death during the follow-up period. Conclusions: These data indicate that the rate of appropriate ICD therapy for primary prevention in HCM is high. The frequencies of inappropriate ICD therapy and complications are low. Family history of SCD is the independent predictor for appropriate therapy of primary prevention ICD.