摘要：目的 通过单中心回顾性研究总结分析埋藏式心脏转复除颤器（implantable cardioverter defibrillator，ICD）不适当治疗的发生率、常见原因、预测因子及对临床预后的影响。方法 2006年1月至 2014年12月在北京协和医学院心内科首次植入ICD，术后规律随诊的患者纳入本研究。收集患者临床资料包括ICD事件记录，由3位有经验的专业医生对ICD治疗事件进行鉴别诊断。不是针对室性心动过速或心室颤动的ICD治疗定义为不适当治疗。结果 共123例患者符合入选标准，中位数随诊时间36个月，共计28例（22.8%）发生不适当治疗，23例（18.7%）发生不适当放电。ICD共记录292次治疗事件，其中不适当治疗161次（55.1%）。心房颤动（atrial fibrillation, AF）/心房扑动（atrial flutter，AFL）是引起不适当治疗的最常见原因（63.3%），AF/AFL病史（OR=5.3，95% CI：1.7~16.4，P=0.004）以及单腔 ICD（OR=5.5，95% CI：1.8-16.3，P=0.002）是不适当治疗的独立预测指标。ICD不适当治疗在心脏性猝死一级预防、二级预防的患者中无显著性差异（P=0.433）。本研究未发现ICD不适当治疗与患者全因病死率之间有相关性。结论 ICD不适当治疗发生率以及不适当治疗事件比例较高，应引起临床医师高度关注；AF/AFL是不适当治疗的主要原因，术前有AF/AFL病史以及单腔ICD是不适当治疗的重要预测指标。
关键词：心脏转复除颤器；不适当治疗；预测因子；心房颤动；心房扑动
中图分类号：R541.7 文献标志码：A　　　文章编号：1007-9688（2016）04-0371-05
Retrospective study of inappropriate implantable cardioverter defibrillator therapies for sudden cardiac death in high-risk patients
CHEN Tai-bo, JIANG Chao, FANG Quan, FAN Jing-bo, GAO Peng, CHENG Kang-an
(Department of Cardiology, Peking Union Medical College Hospital, Beijing 100730, China)
Abstract: Objectives To identify the incidence, common causes, predictors and clinical outcomes of inappropriate implantable cardioverter defibrillator (ICD) therapies in the treatment for sudden cardiac death of high-risk patients. Methods The patients implanted with ICD for the first time and regularly followed up at Peking Union Medical College Hospital from January 2006 to December 2014 were involved in this study. The clinical records on these patients were obtained and the therapies data were examined and printed out by ICD programmer during the follow-up sessions. Three experienced cardiac electrophysiologists reviewed and reevaluated the appropriate use of ICD therapies according to the intracardiac electrocardiogram recordings. Any ICD therapy that was not delivered for ventricular tachycardia or ventricular fibrillation was deemed to be inappropriate. Results In total 123 patients were included in the subsequent study, involving 292 therapy episodes during the median follow-up period of 36 months. For 28 (22.8%) out of the 123 patients, at least one inappropriate therapy occurred. Among the 292 therapy episodes, 161 (55.1%) were identified as inappropriate. Furthermore, we found that atrial fibrillation (AF) / atrial flutter (AFL) was the most common cause of inappropriate therapies (63.3%). A history of AF/AFL (OR=5.3, 95% CI: 1.7~16.4, P=0.004) and single-chamber ICD (OR=5.5, 95% CI: 1.8-16.3, P=0.002) were the independent predictors of inappropriate therapy. No significant difference was observed in the incidence of inappropriate therapy when comparing the primary and secondary prevention groups (P=0.433). In addition, no correlation was found in this study between the inappropriate therapy and all-cause mortality. Conclusions Inappropriate therapies are found common in our study and the most common cause is AF/AFL. A history of AF/AFL and single-chamber ICD are associated with increased risk of inappropriate therapy.
Key words: implantable cardioverter defibrillator; inappropriate therapy; predictive factors; atrial fibrillation; atrial flutter