活跃心律失常模式:ICD冲击的新型预测器-来自PARTITA研究的子分析
Andrea Radinovic1, Daniele Giacopelli2, Caterina Bisceglia1
1Department of Cardiac Arrhythmia and Electrophysiology, San Raffaele University-Hospital, Milan, Italy (A.R., C.B., G.P., A.G., P.D.B.).
Circulation. Arrhythmia and electrophysiology
|May 1, 2024
概括
患有频繁抗心动节拍 (ATP) 的患者面临着植入式心动除器 (ICD) 冲击和心血管事件的高风险. 识别活跃的心律失常模式可以指导这些高风险患者的预防策略.
科学领域:
- 心脏病学 心脏病学
- 电子生理学 电子生理学
- 医疗器械 医疗器械
背景情况:
- 抗心节拍 (ATP) 可以预测植入式心脏转换器除器 (ICD) 冲击.
- 导管切除后ICD冲击减少死亡率和心力衰竭的进展.
- 预防性切除的最佳ATP值仍然没有定义.
研究的目的:
- 确定ATP值和预测ICD冲击和心血管事件的临床因素.
- 根据心律失常模式和临床数据进行风险评估,对患者进行分层.
主要方法:
- 从PARTITA研究 (A期) 中对517名患者的分析.
- 利用分类和回归树分析来开发和验证风险模型.
- 二级终点包括恶化的心力衰竭和心血管住院治疗.
主要成果:
- 一个活跃的心律失常模式 (6个月内≥5个ATP) 确定了患有ICD冲击的最高风险的患者 (93%的培训,86%的测试).
- 在没有ATP的患者中观察到低风险 (1%的培训,2%的测试).
- 左心室喷射率<35%,年龄<60,以及肥胖是额外的预测因素. 活动性心律失常模式显著增加了心力衰竭和心血管住院的风险.
结论:
- 一种活跃的心律失常模式 (≥5ATP/6个月) 表示ICD冲击,心力衰竭和心血管住院的风险增加.
- 预防策略,可能包括早期心室动脉冲动移除,可能有利于这个高风险群体.
- 未来的随机试验是必要的,以验证早期切除的好处.
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