[The assessment of factors influencing occurrence of adequate interventions of cardiac resynchronization therapy with cardioverter-defibrillator implanted in primary prevention of sudden cardiac death in dilative cardiomyopathy and percentage of biventricular pacing].

Przeglad lekarski Pub Date : 2017-01-01

Jacek Lelakowski, Anna Rydlewska, Maria Lelakowska, Joanna Pudło, Justyna Piekarz, Paweł Matusik

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Abstract

The assessment of factors influencing occurrence of adequate interventions of cardiac resynchronization therapy with cardioverter-defibrillator implanted in primary prevention of sudden cardiac death in dilative cardiomyopathy and percentage of biventricular pacing.

Introduction: The function of cardiac resynchronization therapy with cardioverter-defibrillator (CRT-D) is to treat heart failure (HF) and to treat ventricular arrhythmia, if it occurs, with adequate intervention.

Aim: The aim of the study was to find predictors of adequate interventions and in how many patients biventricular pacing percentage decreases during the follow-up.

Material and methods: The study comprised of 228 patients (178 M, mean age 66±10, 31-89 years) with implanted CRTD. The following data were analyzed: age, sex, presence of dilative cardiomyopathy, diabetes mellitus, lowered creatinine clearance, atrial fibrillation (AF), LVEF, NYHA class, adequate interventions, number of arrhythmias, pharmacotherapy modifications, device parameters and mortality.

Results: Mean ejection fraction of the left ventricle was 20.9±6.4, (10.0- 35%). During the mean follow up of 770±490 days in 84 (37%) patients adequate interventions of the device occurred. The adequate interventions concerned mainly patients with diabetes mellitus (HR 2.95), in NYHA class II, with paroxysmal atrial fibrillation (HR 2.15). In 39 patients (17%) the mean percentage of biventricular pacing was below 90%, and in 18 (8%) below 85%.

Conclusions: Diabetes mellitus, NYHA class II, paroxysmal atrial fibrillation have significantly increased the risk of adequate intervention. The most common causes of loss of biventricular pacing were: inappropriate AV delay, supraventricular arrhythmias and premature ventricular complexes. A significant correlation between low biventricular pacing percentage and the occurrence of supraventricular arrhythmias and adequate interventions was observed.

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[在扩张性心肌病心脏猝死一级预防中植入心律转复除颤器的心脏再同步化治疗适当干预发生的影响因素及双室起搏百分比的评估]。

扩张性心肌病心源性猝死一级预防中心脏再同步化治疗植入心律转复除颤器适当干预发生率的影响因素评估及双心室起搏百分比导读:心脏转复除颤器(CRT-D)的心脏同步治疗的功能是治疗心力衰竭(HF)，如果发生室性心律失常，通过适当的干预治疗。目的:本研究的目的是寻找适当干预的预测因素，以及在随访期间有多少患者双心室起搏百分比下降。材料和方法:本研究纳入了228例植入CRTD的患者(178 M，平均年龄66±10岁，31-89岁)。分析以下数据:年龄、性别、是否存在扩张性心肌病、糖尿病、肌酐清除率降低、心房颤动(AF)、LVEF、NYHA分级、适当的干预措施、心律失常次数、药物治疗修改、器械参数和死亡率。结果:左心室平均射血分数为20.9±6.4，(10.0-35%)。在平均770±490天的随访中，84例(37%)患者对器械进行了充分的干预。适当的干预措施主要涉及糖尿病患者(HR 2.95)， nyhacii级，阵发性心房颤动(HR 2.15)。39例(17%)患者双室起搏的平均百分比低于90%，18例(8%)低于85%。结论:糖尿病、NYHA II级、阵发性房颤显著增加适当干预的风险。双室起搏丧失的最常见原因是:不适当的房室延迟、室上心律失常和过早的心室复合体。低双心室起搏率与室上性心律失常的发生有显著的相关性，并观察到适当的干预措施。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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