植入型心律转复除颤器恰当治疗的发放、危险因素及其对预后的影响

The appropriate therapy of implantable cardioverter defibrillator: incidence, predictors and its impact on prognosis

目的本研究旨在利用家庭监测系统了解植入型心律转复除颤器(ICD)术后治疗发放情况、危险因素及其对全因死亡率的影响.方法本研究为多中心、回顾性研究.研究人群来自百多力家庭监测注册研究,入选2010年5月至2015年5月植入德国百多力公司带有家庭监测功能的ICD患者.每半年提取家庭监测随访数据1次,内容包括室性心动过速(室速)及心室颤动(室颤)发作情况,ICD识别和治疗情况.并由电生理专业医生评估ICD疗效,删除不适当识别和治疗事件.本研究终点为全因死亡率.采用单因素和多因素回归分析评估ICD发放治疗的危险因素.Cox回归分析评估ICD治疗事件对终点事件的影响.结果 720例患者入选该研究.在平均(56.4±18.4)个月随访期间,264例(36.7%)患者发生了ICD恰当治疗.二级预防(HR=1.493,95%CI 1.028~2.168.P=0.035),合并心房颤动(房颤,HR=1.856,95%CI 1.025~3.360,P=0.035),合并有晕厥(HR=1.756,95%CI 1.194~2.584,P=0.004)是ICD治疗的独立预测因素.随访期间共有150例(20.8%)患者死亡.ICD治疗事件是全因死亡的独立预测因子(HR=1.92,95%CI 1.30~2.84.P<0.001),其中发生过电除颤治疗事件的患者死亡风险增高2.64倍.结论 4成ICD患者术后曾经发生过恰当治疗.二级预防、合并房颤及晕厥是ICD患者术后发生恰当治疗的预测因子.发生过电除颤治疗的患者,全因死亡率增加2.64倍.

Objective This study aimed to determine appropriate implantable cardioverter defibrillator (ICD) therapy and predictors,to appraise its impact on survival in China.Methods This was a retrospective analysis of 720 consecutive patients with home-monitor ICD from May 2010 to May 2015.The patients were appraised every six months after implantation.The information of ICD therapies was analyzed and inappropriate therapies were excluded.The end point of this study was all-cause death.Multivariate regression and Cox proportional hazard models were used for analysis.Results Totally,720 patients were enrolled.During follow-up of (56.4± 18.4) months,264 (36.7%) patients encountered ICD appropriated therapy.In multivariate analysis,secondary prevention (HR=1.493,95%CI 1.028-2.168,P=0.035),atrial fibrillation (HR=1.856,95%CI 1.025-3.360,P=0.035) and syncope (HR=1.756,95%CI1.194-2.584,P=0.004) werethe independent predictors of ICD appropriated therapy.ICD therapy (HR=1.92,95%CI 1.30-2.84,P<0.001)was associated with increased mortality risk after adjustment.Conclusions The incidence of ICD appropriated therapy is lower than previously trials.Secondary prevention,atrial fibrillation and syncope are the predictors of ICD therapy.All-cause mortality increased by 2.64 times in patients who had undergone electroshock therapy.