程序性心室刺激用于预测心脏结节病患者未来心律失常事件的价值

作     者：Aizer A. Stern E. H. Gomes J. A. D. Mehta 王亭忠 

作者机构：Dr. Zena andMichael A.Wiener Cardiovascular Institute Mount Sinai School of Medicine Mount Sinai Medical Center New York NY United States 

出 版 物：《世界核心医学期刊文摘（心脏病学分册）》 (Digest of the World Core Medical Journals(Cardiology))

年 卷 期：2006年第2卷第1期

页      面：34-35页

学科分类：1002[医学-临床医学] 100201[医学-内科学(含：心血管病、血液病、呼吸系病、消化系病、内分泌与代谢病、肾病、风湿病、传染病)] 10[医学] 

主　　题：心律失常事件 心脏结节病 预测价值 程序性 患者 植入性心脏复律除颤器 心室 室性心律失常 ICD治疗 随访时间 

摘      要：The utility of programmed ventricular stimulation to predict future arrhythmic events in patients with cardiac sarcoidosis is unknown. Similarly, the long-term benefit of implantable cardioverter-defibrillators(ICDs) in cardiac sarcoidosis has not been established. Thirty-two consecutive patients with cardiac sarcoidosis underwent programmed ventricular stimulation. Patients with spontaneous or inducible sustained ventricular arrhythmias(n=12) underwent ICD insertion. All study patients were followed for the combined arrhythmic event end point of appropriate ICD therapies or sudden death. Mean length of follow-up to sustained ventricular arrhythmia or sudden death was 32±30 months. Five of 6 patients(83%) with spontaneous sustained ventricular arrhythmias and 4 of 6 patients(67%) without spontaneous but with inducible sustained ventricular arrhythmias received appropriate ICD therapy. Two of 20 patients(10%) with neither spontaneous nor inducible sustained ventricular arrhythmias experienced sustained ventricular arrhythmias or sudden death. Programmed ventricular stimulation predicted subsequent arrhythmic events in the entire population(relative hazard 4.47, 95%confidence interval[CI] 1.30 to 15.39) and in patients who presented without spontaneous sustained ventricular arrhythmias(relative hazard 6.97, 95%CI 1.27 to 38.27). No patient with an ICD died of a primary arrhythmic event. In patients with spontaneous or inducible sustained ventricular arrhythmias, mean survival from first appropriate ICD therapy to death or cardiac transplant was 60±46 months, with only 2 patients dying or reaching transplant at study end. In conclusion, programmed ventricular stimulation identifies patients with cardiac sarcoidosis at high risk for future arrhythmic events. ICDs effectively terminate life-threatening arrhythmias in high-risk patients, with significant survival after first appropriate therapy.