新型冠状病毒肺炎疫情期间植入式心脏自动复律除颤器患者的随访和预后分析

Follow-up and prognosis analysis of patients with implantable cardioverter defi brillators during the COVID-19 epidemic

目的探讨新型冠状病毒肺炎(COVID-19)疫情期间植入式心脏自动复律除颤器(ICD)患者随访情况和不良心血管事件的变化。方法回顾北京大学第一医院自2019年1月24日至2020年7月16日随访的ICD患者人群,研究组定义为2020年1月24日至7月16日随访ICD患者,与对照组定义为疫情前同期(2019年1月24至7月16日)及研究组自身既往2019年7月24日至2020年1月16日对比随访方式和不良心血管事件发生情况。结果研究组ICD患者66例,其中42例(63.6%)电话随访;对照组59例患者全部诊室随访。研究组患者发生包括电击、心力衰竭加重、心脏原因入院、移植及臆测报警、起搏和除颤阈值升高、电量提前耗竭的事件共22例次。电击共147频次。对照组仅发生5例次事件,电击7频次。Poisson回归证实研究组不良心血管事件和器械相关不良事件发生风险有近4倍升高[相对风险(RR)3.66,95%可信区间(CI):1.44~9.29,P=0.006],总的电击风险升高达17倍(RR 17.58,95%CI 8.44~36.60,P<0.001)。研究组与既往自身对照,患者在疫情期间不良事件也显著增加,且均主诉焦虑恐惧,而无心肌缺血,药物不依从等,亦未感染COVID-19。结论ICD患者疫情期间精神心理状态值得关注,加强远程随访指导和心理干预可能有助于减少该类患者不良心血管事件的发生。

Objective To evaluate the possible association of the COVID-19 epidemic on the approach of follow-up and prognosis of the patients with implantable cardioverter defi brillators(ICDs).Methods Retrospective analysis of the cardiovascular events of our ICD patients from Jan 24,2019 to July 162020,the data of follow-up methods and cardiovascular events records and control data during the same period last year for the same patients were compared.Results Sixty-six patients with ICD were followed-up during the COVID-19 epidemic,and 42 cases(63.6%)were contacted with telephone-visit.In comparison,all of the 59 patients with ICD were followed-up by inoffi ce visits during the same period of last year.A total of 22 cardiovascular events including shocks,exacerbation of heart failure,rehospitalization for cardiac reasons,referral for heart transplantation,fake alarm,elevated thresholds for pacing and defibrillation,and premature exhaustion of battery occurred.Shocks were delivered 147 times.In contrast,only 5 cardiac or devices-associated-endpoints and 7 shocks occurred in the same period last year.Signifi cantly elevated risks for cardiac adverse outcomes and shocks were demonstrated in the Poisson regression model[relative risk ratio(RR)and 95%confi dence intervals(CI)were 3.66(1.44-9.29),P=0.006,and 17.58(8.44-36.60),P<0.001;respectively).Patients also documented signifi cantly increased adverse events than in their past history,and reported anxiety and horror instead of myocardial ischemia or incompliance to medication.None of the patients got an infection of COVID-19.Conclusions The psychiatric status of patients with ICD needs to be paid more attention during the epidemic.It would be helpful to reinforce remote follow-up and early psychological intervention.