電気嵐は突然の死を予知しない:抗リズム薬と埋め込み式除細動器 (AVID) 試験
D V Exner1, S L Pinski, D G Wyse
1University of Calgary, Canada. exner@ucalgary.ca
Circulation
|April 25, 2001
まとめ
24時間以内に複数の心房不律のエピソードとして定義される電気嵐は,インプラント可能な心臓変容器除細動器受容者の死亡リスクを大幅に増加させます. このリスクは,事件後の最初の3ヶ月で最も高い.
科学分野:
- 心臓病学 心臓病学
- 電気生理学 電気生理学
- 医療機器 医療機器について
背景:
- 再発性心房短拍 (VT) または心房細動 (VF) が特徴である電気嵐は,移植性心房変圧器 (ICD) を使用している患者の既知の合併症です.
- この患者集団における電気嵐の予後的な影響に関するデータは限られている.
研究 の 目的:
- ICDを受けた患者の電気嵐の予後的意義を調査する.
- 電気嵐を経験した患者のアウトカムと,単発のVT/VFエピソードを経験した患者のアウトカムを比較する.
主な方法:
- ICDを用いた抗不律薬対埋め込み式除細動器 (AVID) 試験の457人の患者の分析.
- 24時間以内にVT/VFのエピソードが3回以上発生すると定義される電気嵐.
- 時間の依存性Coxモデリングを用いた生存分析で,電気嵐,単離VT/VF,イベントなしの患者を比較した.
主要な成果:
- 電気嵐はICDの導入後平均9.2ヶ月で発生し,主にVT (86%) として発生しました.
- 電気嵐は,その後の死亡の有意な独立した予測因子であった (RR 2.4,P=0.003).
- 死の危険性は,嵐の発生後3ヶ月以内に大幅に上昇した (RR 5.4,P<0.0001),その後減少した.
結論:
- 電気嵐は,ICD受給者の死亡リスクの増加の重要な独立したマーカーです.
- 嵐の後のリスクは,最初の3ヶ月で最も顕著です.
- 電気嵐の基準を満たさない静脈動脈短拍 / 動のエピソードは,死亡リスクを増加させるようには見えませんでした.
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