植入心律转复除颤器患者预后的影响因素

Influence factors of prognosis in patients with implantable cardioverter defibrillator

目的分析影响植入心律转复除颤器(implantable cardioverter defibrillator,ICD)患者预后的临床因素。方法回顾性分析2014年12月至2018年12月于山西省心血管病医院行ICD及心脏再同步化起搏-除颤器(cardiac resynchronization pacemaker defibrillator,CRTD)植入术的患者的临床资料,术后发生室性心律失常的患者设为A组,未发生的患者设为B组。分析影响术后室性心律失常和临床事件(死亡或再住院)发生的因素,并作生存分析及COX多因素分析。结果共纳入87例患者,中位随访28.4个月,A组44例(50.5%),其中23例(26.4%)进行了恰当电击,B组43例中有8例(9.2%)进行了误电击。生存分析显示,相比于术前QT间期离散度(QT interval dispersion,QTd)<80 ms患者,QTd≥80 ms患者术后室性心律失常发生率(P<0.001)及临床事件发生率(P=0.001)较高,差异有统计学意义。对术后室性心律失常和临床事件作多因素分析发现,术前QTd≥80 ms是术后发生室性心律失常(HR=8.493,95%CI:3.348~21.544,P<0.001)和死亡或再住院(HR=3.788,95%CI:1.756~8.172,P=0.001)的危险因素,胺碘酮(HR=0.375,95%CI:0.153~0.921,P=0.032)可降低术后室性心律失常的发生。结论术前QTd≥80 ms是ICD或CRTD植入患者术后发生室性心律失常和死亡或再住院的危险因素,而胺碘酮可有效降低室性心律失常发生率。

Objectives To analyze the clinical factors influencing the prognosis of patients with implantable cardioverter defibrillator(ICD).Methods Clinical data of ICD and cardiac resynchronization pacemaker-defibrillator(CRTD)implantation patients from December 2014 to December 2018 in Shanxi Cardiovasular Hospital was retrospectively analyzed.The patients occurred postoperative ventricular arrhythmia were assigned to A group,otherwise to B group.Risk factors of postoperative ventricular arrhythmia(ventricular tachycardia or ventricular fibrillation)events and clinical events(death or rehospitalization)were analyzed.Survival analysis and COX regression analysis of multiple factors were done.Results A total number of 87 patients were enrolled.The median follow-up was 28.4 months.There were 44 patients(50.5%)in A group after surgery,23(26.4%)received appropriate electric shocks.In B group,8 of the 43 patients(9.2%)received false electric shocks.Survival analysis showed that patients with preoperative QT interval dis⁃persion(QTd)≥80 ms had higher rate of postoperative ventricular arrhythmia(P<0.001)and higher rate of clinical events(P=0.001)compared with patients who had preoperative QT interval dispersion(QTd)<80 ms.Multiariable analysis showed that the preoperative QTd≥80 ms was a risk factor for postoperative ventricular arrhythmia(HR=8.493,95%CI:3.348-21.544,P<0.001)and death or rehospitalization(HR=3.788,95%CI:1.756-8.172,P=0.001),amiodarone(HR=0.375,95%CI:0.153-0.921,P=0.032)can reduce the occurrence of postoperative ventricular arrhythmia.Conclusions Preoperative QTd≥80 ms is a risk factor for postoperative ventricular arrhythmia and death or rehospitalization in patients who had implanted ICD or CRTD,while the use of amiodarone can effectively re⁃duce the incidence of ventricular arrhythmia.