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首页> 外文期刊>Circulation. Arrhythmia and electrophysiology >Primary prevention of sudden cardiac death in a nonischemic dilated cardiomyopathy population reappraisal of the role of programmed ventricular stimulation
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Primary prevention of sudden cardiac death in a nonischemic dilated cardiomyopathy population reappraisal of the role of programmed ventricular stimulation

机译:对非缺血性扩张型心肌病人群中心源性猝死的一级预防,对程序性心室刺激的作用进行重新评估

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Background-We considered the role of programmed ventricular stimulation in primary prevention of sudden cardiac death in an idiopathic dilated cardiomyopathy population. Methods and Results-One hundred fifty-eight patients with idiopathic dilated cardiomyopathy underwent programmed ventricular stimulation. Ventricular tachycardia/ventricular fibrillation was triggered in 44 patients (group I, 27.8%) versus 114 patients (group II), where ventricular tachycardia/ventricular fibrillation was not induced. Sixty-nine patients with idiopathic dilated cardiomyopathy underwent implantable cardioverter- defibrillator (ICD) implantation: 41/44 in group I and 28/114 in group II. The major end points of the study were overall mortality and appropriate ICD activation. Overall mortality during the 46.9 months of mean follow-up was not significantly different between the 2 groups. Patients with left ventricular ejection fraction ≤35% (n=119) demonstrated a higher overall mortality rate compared with the patients with left ventricular ejection fraction >35% (n=39; 16.8% versus 10.3%, log-rank P=0.025). Advanced New York Heart Association class (III and IV versus I and II) was the single independent and strongest prognostic factor of overall mortality (hazard ratio, 11.909; P<0.001; confidence interval, 3.106-45.65), as well as of cardiac mortality (hazard ratio, 14.787; P=0.001; confidence interval, 2.958-73.922). Among ICD recipients, ICD activation rate was significantly higher in group I compared with group II (30 of 41 patients-73.2% versus 5 of 28 patients-17.9%; log-rank P=0.001), either in the form of antitachycardia pacing (68.3% versus 17.9%; log-rank P=0.001) or in the shock delivery form (51.2% versus 17.9%; log-rank P=0.05). Induction of ventricular tachycardia/ventricular fibrillation during programmed ventricular stimulation in contrast to left ventricular ejection fraction was the single independent prognostic factor for future ICD activation (hazard ratio, 4.195; P=0.007; confidence interval, 1.467-11.994). Conclusions-Inducibility of ventricular tachycardia/ventricular fibrillation was associated with an increased likelihood of subsequent ICD activation and sudden cardiac death surrogate.
机译:背景-我们考虑了程序性心室刺激在特发性扩张型心肌病人群中预防心源性猝死的一级作用。方法和结果-158例特发性扩张型心肌病患者接受了程序性心室刺激。 44例患者(I组,27.8%)触发了室性心动过速/心室纤颤,而114例(II组)未引发室性心动过速/心室纤颤。 69例特发性扩张型心肌病患者接受了植入式心脏复律除颤器(ICD)植入:第一组为41/44,第二组为28/114。该研究的主要终点是总体死亡率和适当的ICD激活。两组之间平均随访46.9个月的总死亡率无显着差异。左心室射血分数≤35%(n = 119)的患者与左心室射血分数> 35%(n = 39; 16.8%对10.3%,对数秩P = 0.025)的患者相比,具有更高的总体死亡率。 。纽约心脏协会高级分类(III和IV与I和II)是总死亡率(危险比,11.909; P <0.001;置信区间,3.106-45.65)以及心脏死亡率的唯一独立且最强的预后因素(危险比14.787; P = 0.001;置信区间2.958-73.922)。在ICD接受者中,第一组的ICD激活率明显高于第二组(41名患者中的30名73.2%比28名患者中的5名17.9%;对数秩P = 0.001),两种形式均为抗心动过速起搏( 68.3%对17.9%;对数秩P = 0.001)或电击送递形式(51.2%对17.9%;对数秩P = 0.05)。与左心室射血分数相反,在程序性心室刺激期间诱发心室心动过速/心室纤颤是未来ICD激活的唯一独立预后因素(危险比为4.195; P = 0.007;置信区间为1.467-11.994)。结论室性心动过速/心室颤动的可诱导性与随后ICD激活和心源性猝死替代的可能性增加有关。

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