埋藏式心脏转复除颤器一级预防患者恶性室性心律失常的发生及影响因素分析

Predictors of malignant ventricular arrhythmia in patients with implantable cardioverter defibrillator for primary prevention of sudden cardiac death

目的分析比较埋藏式心脏转复除颤器(ICD)一级预防和二级预防患者每年恶性室性心律失常发生率的异同,明确ICD一级预防患者发生恶性室性心律失常的可能预测因素.方法连续入选2010年1月至2016年12月于大连医科大学附属第一医院行ICD治疗的患者,随访至少4年,比较一级预防与二级预防组术后每年累积恶性室性心律失常的发生率,以及一级预防组发生恶性室性心律失常(高危)者与非恶性心律失常(低危)者年龄、性别、基础疾病史、治疗药物、超声心动图指标、体表心电图指标、血清学指标等资料的差异.结果一级预防的患者79例,二级预防的患者93例.从ICD一级预防和二级预防患者术后第4年始,恶性室性心律失常累计年发生率无差异(29.1%vs 43.0%,P=0.059).一级预防患者中术后发生室性心动过速(简称室速)、心室颤动(简称室颤)的24例,占一级预防总例数的30.4%.单因素分析显示左室舒张末内径(P=0.007),年龄(P=0.004),室性早搏个数(P<0.001)、左室射血分数(P=0.036)、室间隔厚度(P=0.034)是一级预防患者发生室速、室颤的可能预测因素;进一步多因素分析显示,年龄(OR=0.926,95%CI 0.878~0.978,P=0.005)及左室射血分数(OR=0.947,95%CI 0.906~0.990,P=0.017)对发生恶性室性心律失常有预测价值.结论ICD一级预防的患者,术后第4年开始发生恶性室性心律失常的风险与二级预防患者无明显差异.左室射血分数及年龄是ICD猝死一级预防患者发生室速、室颤的预测因素.左室射血分数越低,年龄越小,越容易发生室速及室颤.

Objective To compare the annual incidence of malignant ventricular arrhythmias in patients with primary and secondary prevention of implantable cardioverter defibrillator(ICD)and identify the possible predictors of patients with malignant ventricular arrhythmias in the patients with ICD for primary prevention of sudden death.Methods The patients with ICD as primary prevention and secondary prevention were enrolled in this study in the First Affiliated Hospital of Dalian Medical University from January 2010 to December 2016.Followed up for at least 4 years.The annual incidence of cumulative ventricular arrhythmias was compared between the primary prevention and secondary prevention groups.According to the occurrence of malignant ventricular arrhythmia after operation,the primary prevention groups were divided into high and low risk groups.We had collected baseline data,like age,gender,history of underlying diseases,treatment drugs,Grading,echocardiographic parameters,12-conductor ECG,serum markers.Compare the differences in data between high and low risk groups.Results There were 79 patients with primary prevention and 93 patients with secondary prevention.There was no difference in the cumulative incidence of malignant ventricular arrhythmias at the fourth year after primary prevention and secondary prevention of ICD(29.1%vs 43.0%,P=0.059).Twenty-four cases of ventricular tachycardia(VT)and ventricular fibrillation(VF)occurred in primary prevention patients,accounting for 30.4%of primary prevention cases.Univariate analysis showed that the left ventricular end-diastolic diameter(P=0.007),the age(P=0.004),the number of premature ventricular contraction,the left ventricular ejection fraction(LVEF)(P=0.036)and the interventricular septum thickness(P=0.034)were the predictors of VT and VF.Multivariate analysis showed that the mean age(OR=0.926,95%CI0.878-0.978,P=0.005)and LVEF(OR=0.947,95%CI 0.906-0.990,P=0.017)had predictive value for the occurrence of malignant ventricular arrhythmias.Conclusion The risk of malignant ventricular arrhythmia was equally high in the primary prevention and secondary prevention groups after three years.The age and LVEF value may be the predictors of VT and VF in the primary prevention population.If the patients with the low LVEF values and young,they are more likely to occur VT and VF.