心律转复除颤器植入术后电风暴的发生及其对预后的影响

目的调查单中心心律转复除颤器（ICD）植入术后电风暴（ES）的发生率、发作特征和危险因素，并探讨其对患者预后的影响。方法对本中心123例植入ICD的患者进行随访。Es定义为24h内出现3次或3次以上的快速室性心律失常（VA）导致ICD治疗，或ICD监测到持续30s以上的VA但未发放治疗。结果在（26．9±21．3）个月的随访期间，共有41（33．3％）例患者（ES组）发作139次ES（3．4±3．9）次／例，其中29（70．7％）例患者的首次发作在植入后1年内出现，Es发作呈现出6：00—10：00和14：00～17：00两个高峰。多因素Logistic回归分析表明植入ICD作为心脏性猝死二级预防是ES发生的独立危险因素（OR=4．797，P=0．044）。本组共15（12．2％）例患者死亡，Es组死亡率较无Es组（24．4％对6．1％，P=0．003）显著增高，Kaplan—Meier生存曲线分析显示Es组累计生存概率明显低于无Es组（Log—rank检验P〈0．001）。结论Es发作表现为上午和下午两个高峰，可导致死亡率增高，其首次发作多在ICD植入后1年内。植入ICD作为心脏性猝死二级预防是Es发生的独立危险因素。

Electrical storm in recipients with implantable cardioverter defibrillators

Objective To explore the incidence,predictors and prognostic value of electrical storm (ES) in patients with implantable cardioverter defibrillators (ICD). Methods One hundred and twenty-three ICD recipients were enrolled in this study. ES was defined as either ≥3 times of ventricular arrhythmia (VA) episodes resulting in ICD therapy or lasting more than 30s detected by ICD without therapy within 24 hours. Results During a mean follow-up period of(26.9±21.3) months,139 episodes of ES(3.4±3.9 times per patient) were encountered in 41(33.3% ) cases35 males,average age(50.8±11.4)years]. Most of the ES(29 patients ,70.7% ) episodes occurred in the first year after implantation. The episodes of ES occurred at any time of the day,and enriched in two peak duration(6:00-10:00 am and 14:00-17:00 pm). The study suggested that either ICD therapy for secondary prevention of sudden cardiac death or the use of amiodarone was correlated with ES using univariate Logistic regression analysis. Only the former is an independent predictor of ES( OR = 4. 797, P=0. 044) using multivariate Logistic regression analysis. Fifteen patients, ten of which experienced ES,died during the follow-up. Compared with 82 patients without ES,the mortality of the patients with ES was dramatically higher(24.4% vs 6. 1% ,P=0.003).The accumulate survival rate was significantly decreased in patients with ES( Log-rank test ,P<0.001) using Kaplan-Meier survive curve analysis. Conclusions ICD therapy for secondary prevention of sudden cardiac death was one of the independent predictors of ES. Most of the ES developed during the first year after implantation and clustered in the morning and afternoon. The mortality was higher in the ICD recipients experienced ES.