Heart:超半数ICD置入者适宜初始S-ICD置入
2013-05-28 Heart CMT 高晓方 编译
荷兰一项研究表明,超过半数的置入型心律转复除颤器(ICD)患者适合初始接受皮下ICD(S-ICD)治疗,并且数项基线临床特征有助于选择适宜患者。论文于5月23日在线发表于《心脏》(Heart)。 此项回顾性队列研究共纳入1345例接受单腔或双腔ICD治疗的患者,并进行了为期5年的随访。以随访期间未到达下述终点之一定义适合S-ICD治疗:心房和/或右室起搏适应证;无后续休克的成功抗心动过速
荷兰一项研究表明,超过半数的置入型心律转复除颤器(ICD)患者适合初始接受皮下ICD(S-ICD)治疗,并且数项基线临床特征有助于选择适宜患者。论文于5月23日在线发表于《心脏》(Heart)。
此项回顾性队列研究共纳入1345例接受单腔或双腔ICD治疗的患者,并进行了为期5年的随访。以随访期间未到达下述终点之一定义适合S-ICD治疗:心房和/或右室起搏适应证;无后续休克的成功抗心动过速性起搏;升级至CRT-D设备。
结果显示,在中位3.4年随访其中,463例(34%)患者达到一项终点。5年之后,适合初始S-ICD治疗的ICD置入者的累积发生率为55.5%。不适合S-ICD治疗的显著预测因素包括二级预防、严重心衰和QRS持续时间延长。
Objective
To assess the proportion of current implantable cardioverter defibrillator (ICD) recipients who would be suitable for a subcutaneous lead ICD (S-ICD).
Design
A retrospective cohort study.
Setting
Tertiary care facility in the Netherlands.
Patients
All patients who received a single- or dual-chamber ICD in the Leiden University Medical Center between 2002 and 2011. Patients with a pre-existent indication for cardiac pacing were excluded.
Main outcome measure
Suitability for an S-ICD defined as not reaching one of the following endpoints during follow-up: (1) an atrial and/or right ventricular pacing indication, (2) successful antitachycardia pacing without a subsequent shock or (3) an upgrade to a CRT-D device.
Results
During a median follow-up of 3.4 years (IQR 1.7–5.7 years), 463 patients (34% of the total population of 1345 patients) reached an endpoint. The cumulative incidence of ICD recipients suitable for an initial S-ICD implantation was 55.5% (95% CI 52.0% to 59.0%) after 5 years. Significant predictors for the unsuitability of an S-ICD were: secondary prevention, severe heart failure and prolonged QRS duration.
Conclusions
After 5 years of follow-up, approximately 55% of the patients would have been suitable for an S-ICD implantation. Several baseline clinical characteristics were demonstrated to be useful in the selection of patients suitable for an S-ICD implantation.
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