长期监测遗传性心律失常患者的心脏性猝死风险

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS CJC Open Pub Date : 2024-09-01 DOI:10.1016/j.cjco.2024.05.007
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引用次数: 0

摘要

背景遗传性心律失常综合征的风险分层具有挑战性。植入式心律转复除颤器(ICD)能有效预防心脏性猝死,但也会带来严重的并发症。我们旨在确定长期植入式环路记录器(ILR)监测对确定遗传性心律失常患者心律失常风险因素的价值。方法我们在 2015 年至 2020 年期间开展了一项前瞻性多中心研究,招募了处于中度心律失常风险的遗传性心律失常疑似患者和家庭成员,他们没有 ICD 植入的 1 类适应症。主要终点是通过 ILR 检测到连续≥10 次的非持续性室速。次要终点包括随访期间的 ICD 植入情况、全因死亡率和 ILR 并发症发生率。最常见的诊断为长 QT 综合征(28%)、Brugada 综合征(26%)和致心律失常性心肌病(11%)。植入 ILR 后(平均随访 633 天;范围:387-969),45 名患者中有 19 人(42%)出现心脏症状,其中 5 人出现非持续性室性心动过速(11%),3 人出现症状。在这种情况下,45 名患者中有 5 人(11%)根据 ILR 植入了 ICD。50%的症状性事件发生在 ARVC 患者身上。从植入 ILR 到植入 ICD 的中位时间为 152 天(四分位距(第 25、75 百分位数)为 55,共 209 天)。结论 ILR 能够检测高危心律失常特征,有助于为有边缘适应症的遗传性心律失常患者选择 ICD 候选者。
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Long-term Monitoring to Detect Risk of Sudden Cardiac Death in Inherited Arrhythmia Patients

Background

Risk stratification in inherited arrhythmia syndromes is challenging. Implantable cardioverter defibrillators (ICDs) are effective in the prevention of sudden cardiac death but are associated with significant complications. We aimed to determine the value of long-term implantable loop recorder (ILR) monitoring to determine risk factors for arrhythmias in inherited arrhythmia patients.

Methods

We conducted a prospective multicentre study between 2015 and 2020 recruiting inherited arrhythmia probands and family members at intermediate arrhythmic risk, with no class 1 indication for ICD implantation. The primary endpoint was the detection by ILR of nonsustained ventricular tachycardia over ≥ 10 consecutive beats. Secondary endpoints included ICD insertion during follow-up, all-cause mortality, and ILR complication rates.

Results

A total of 45 individuals (30 female participants) were enrolled in the study. The most common diagnoses were long-QT syndrome (28%), Brugada syndrome (26%), and arrhythmogenic cardiomyopathy (11%). Following ILR insertion (mean follow-up 633 days; range, 387-969), cardiac symptoms occurred in 19 of 45 patients (42%), 5 of whom had nonsustained ventricular tachycardias (11%), which were symptomatic in 3 individuals. This situation led to ICD implantation based on ILR in 5 of 45 patients (11%). Fifty percent of symptomatic events occurred in ARVC patients. The median time from ILR insertion to ICD implantation was 152 days (interquartile range (25th, 75th percentiles) 55 of 209). No patient experienced sudden cardiac death.

Conclusions

ILRs enable the detection of high-risk arrhythmic features and facilitate selection of ICD candidates in inherited arrhythmia patients with borderline indications.

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来源期刊
CJC Open
CJC Open Medicine-Cardiology and Cardiovascular Medicine
CiteScore
3.30
自引率
0.00%
发文量
143
审稿时长
60 days
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