Implantable cardioverter-defibrillator (ICD) in heart failure with reduced ejection fraction (EF) patients reduces risk for sudden cardiac death (SCD). Previous data suggest that the benefit of ICD therapy in real lif...Implantable cardioverter-defibrillator (ICD) in heart failure with reduced ejection fraction (EF) patients reduces risk for sudden cardiac death (SCD). Previous data suggest that the benefit of ICD therapy in real life may be lower than expected from the results of controlled studies and only about one-third of ICD patients receive appropriate therapies. Nevertheless, all ICD patients are at risk of perioperative complications and inappropriate shocks. We retrospectively studied 613 patients undergoing ICD for primary prevention in 2002-2015;we excluded inherited arrhythmogenic syndromes. Patients underwent 12-leads ECG, echocardiography, laboratory tests and quality of life questionnaire. We evaluated comorbidities, appropriate therapies, complications and all-cause mortality. Consecutive patients (age 67 ± 10 years, 81% males, 59% ischaemic aetiology) were followed for 51 ± 31 months. 198 patients (32%) received appropriate ICD therapy, 93 (15%) had inappropriate shocks, 53 (8%) had at least one complication (electrode dysfunction, infection and pocket related) and 191 (33%) died. Multivariate analysis showed atrial fibrillation (OR = 1.8, CI = 1.27 - 2.53;p < 0.01), diabetes (OR = 1.8, CI = 1.27 - 2.53;p = 0.041) and vasculopathy (OR = 1.8, CI = 1.27 - 2.53;p = 0.031) as predictors of appropriate therapy. Logistic regression, considering atrial fibrillation, diabetes, vasculopathy, EF, NYHA class, left atrial diameter and natremia, identified SCD low risk group (probability < 0.1258). Ventricular arrhythmias necessitating ICD therapy are common, but complications and inappropriate therapies are frequent. Many parameters should be considered for a better selection of ICD candidates, to reduce ineffective implants. Our multifactorial score may eventually reduce about 10% ICD implantation.展开更多
AIM: To evaluate the safety and efficacy of the permanent high interventricular septal pacing in a long term follow up, as alternative to right ventricular apical pacing. METHODS: We retrospectively evaluated:(1) 244 ...AIM: To evaluate the safety and efficacy of the permanent high interventricular septal pacing in a long term follow up, as alternative to right ventricular apical pacing. METHODS: We retrospectively evaluated:(1) 244 patients(74 ± 8 years; 169 men, 75 women) implanted with a single(132 pts) or dual chamber(112 pts) pacemaker(PM) with ventricular screw-in lead placed at the right ventricular high septal parahisian site(SEPTAL pacing);(2) 22 patients with permanent pacemaker and low percentage of pacing(< 20%)(NO pacing);(3) 33 patients with high percentage(> 80%) right ventricular apical pacing(RVA). All patients had a narrow spontaneous QRS(101 ± 14 ms). We evaluated New York Heart Association(NYHA) class, quality of life(Qo L), 6 min walking test(6MWT) and left ventricular function(end-diastolic volume, LV-EDV; end-systolic volume, LVESV; ejection fraction, LV-EF) with 2D-echocardiography. RESULTS: Pacing parameters were stable duringfollow up(21 mo/patient). In SEPTAL pacing group we observed an improvement in NYHA class, Qo L score and 6MWT. While LV-EDV didn't significantly increase(104 ± 40 m L vs 100 ± 37 m L; P = 0.35), LV-ESV slightly increased(55 ± 31 m L vs 49 ± 27 m L; P = 0.05) and LV-EF slightly decreased(49% ± 11% vs 53% ± 11%; P = 0.001) but never falling < 45%. In the RVA pacing control group we observed a worsening of NYHA class and an important reduction of LV-EF(from 56% ± 6% to 43% ± 9%, P < 0.0001).CONCLUSION: Right ventricular permanent high septal pacing is safe and effective in a long term follow up evaluation; it could be a good alternative to the conventional RVA pacing in order to avoid its deleterious effects.展开更多
文摘Implantable cardioverter-defibrillator (ICD) in heart failure with reduced ejection fraction (EF) patients reduces risk for sudden cardiac death (SCD). Previous data suggest that the benefit of ICD therapy in real life may be lower than expected from the results of controlled studies and only about one-third of ICD patients receive appropriate therapies. Nevertheless, all ICD patients are at risk of perioperative complications and inappropriate shocks. We retrospectively studied 613 patients undergoing ICD for primary prevention in 2002-2015;we excluded inherited arrhythmogenic syndromes. Patients underwent 12-leads ECG, echocardiography, laboratory tests and quality of life questionnaire. We evaluated comorbidities, appropriate therapies, complications and all-cause mortality. Consecutive patients (age 67 ± 10 years, 81% males, 59% ischaemic aetiology) were followed for 51 ± 31 months. 198 patients (32%) received appropriate ICD therapy, 93 (15%) had inappropriate shocks, 53 (8%) had at least one complication (electrode dysfunction, infection and pocket related) and 191 (33%) died. Multivariate analysis showed atrial fibrillation (OR = 1.8, CI = 1.27 - 2.53;p < 0.01), diabetes (OR = 1.8, CI = 1.27 - 2.53;p = 0.041) and vasculopathy (OR = 1.8, CI = 1.27 - 2.53;p = 0.031) as predictors of appropriate therapy. Logistic regression, considering atrial fibrillation, diabetes, vasculopathy, EF, NYHA class, left atrial diameter and natremia, identified SCD low risk group (probability < 0.1258). Ventricular arrhythmias necessitating ICD therapy are common, but complications and inappropriate therapies are frequent. Many parameters should be considered for a better selection of ICD candidates, to reduce ineffective implants. Our multifactorial score may eventually reduce about 10% ICD implantation.
文摘AIM: To evaluate the safety and efficacy of the permanent high interventricular septal pacing in a long term follow up, as alternative to right ventricular apical pacing. METHODS: We retrospectively evaluated:(1) 244 patients(74 ± 8 years; 169 men, 75 women) implanted with a single(132 pts) or dual chamber(112 pts) pacemaker(PM) with ventricular screw-in lead placed at the right ventricular high septal parahisian site(SEPTAL pacing);(2) 22 patients with permanent pacemaker and low percentage of pacing(< 20%)(NO pacing);(3) 33 patients with high percentage(> 80%) right ventricular apical pacing(RVA). All patients had a narrow spontaneous QRS(101 ± 14 ms). We evaluated New York Heart Association(NYHA) class, quality of life(Qo L), 6 min walking test(6MWT) and left ventricular function(end-diastolic volume, LV-EDV; end-systolic volume, LVESV; ejection fraction, LV-EF) with 2D-echocardiography. RESULTS: Pacing parameters were stable duringfollow up(21 mo/patient). In SEPTAL pacing group we observed an improvement in NYHA class, Qo L score and 6MWT. While LV-EDV didn't significantly increase(104 ± 40 m L vs 100 ± 37 m L; P = 0.35), LV-ESV slightly increased(55 ± 31 m L vs 49 ± 27 m L; P = 0.05) and LV-EF slightly decreased(49% ± 11% vs 53% ± 11%; P = 0.001) but never falling < 45%. In the RVA pacing control group we observed a worsening of NYHA class and an important reduction of LV-EF(from 56% ± 6% to 43% ± 9%, P < 0.0001).CONCLUSION: Right ventricular permanent high septal pacing is safe and effective in a long term follow up evaluation; it could be a good alternative to the conventional RVA pacing in order to avoid its deleterious effects.
