Clusters of ventricular tachycardias signify impaired survival in patients with idiopathic dilated cardiomyopathy and implantable cardioverter defibrillators

被引:112
作者
Bänsch, D
Böcker, D
Brunn, J
Weber, M
Breithardt, G
Block, M
机构
[1] St George Hosp, Dept Cardiol, D-20099 Hamburg, Germany
[2] Univ Munster, Dept Cardiol, D-4400 Munster, Germany
[3] Univ Munster, Inst Arteriosclerosis Res, D-4400 Munster, Germany
关键词
D O I
10.1016/S0735-1097(00)00726-9
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
OBJECTIVES This retrospective study was undertaken to provide data on occurrence, significance and therapy of ventricular tachyarrhythmia (VT) dusters (VTCs) in patients with dilated cardiomyopathy (DCM) and implantable cardioverter defibrillators (ICDs). BACKGROUND Data on the clinical significance of VTCs are lacking in patients with DCM and ICDs. METHODS Baseline characteristics of 106 consecutive patients with DCM and ICDs were prospectively collected, and chart reviews and episode data retrospectively analyzed. A VTC was defined as greater than or equal to 3 sustained VTs/24 h. RESULTS During a mean follow-up of 33 +/- 23 months, 73 patients (68.9%) had recurrent VT or ventricular fibrillation (VF), 43 patients (40.6%) suffered only single VTs and 30 patients (28.3%) experienced 52 clusters of VTs. Actuarial survival free of VT or VF tvas 44.6%, 33.0%, and 26.5%, and survival free of VTC was 77.3%, 72.2% and 67.1% after one, two and three years, respectively. Independent predictors of VT dusters were heart failure before ICD implantation (p = 0.033), presenting monomorphic VT (p = 0.044), EF <0.40 (p = 0.014) and inducible mVT, especially with right bundle branch block and superior axis configuration (p < 0.001). Survival free of recurrent VTCs was 50.8%, 38.1% and 19.0%, after one, two and three years, respectively. Once a VTC had occurred, only 56.7%, 46.4%, 30.9% and 15.5% of patients survived and were not transplanted after one, two, three and four years, respectively. Survival tvas even more reduced ifa VTC was associated with cardiac decompensation: 65.6%, and 21.9%, after one and two years, respectively. CONCLUSIONS Despite antiarrhythmic intervention, clusters of VTs occur and recur frequently in patients with DCM. They signify impaired survival, especially if they are associated with cardiac decompensation, and may be a harbinger of progressive myocardial deterioration rather than a primarily arrhythmic problem. The benefit of ICD therapy may therefore be low in these patients, (C) 2000 by the American College of Cardiology.
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页码:566 / 573
页数:8
相关论文
共 35 条
  • [11] Incidence and clinical significance of short-term recurrent ventricular tachyarrhythmias in patients with implantable cardioverter-defibrillator
    Fries, R
    Heisel, A
    Huwer, H
    Nikoloudakis, N
    Jung, J
    Schafers, J
    Schieffer, H
    Ozbek, C
    [J]. INTERNATIONAL JOURNAL OF CARDIOLOGY, 1997, 59 (03) : 281 - 284
  • [12] CONTROL OF REFRACTORY VENTRICULAR-TACHYCARDIA WITH BIVENTRICULAR ASSIST DEVICES
    GEANNOPOULOS, CJ
    WILBER, DJ
    OLSHANSKY, B
    [J]. PACE-PACING AND CLINICAL ELECTROPHYSIOLOGY, 1991, 14 (09): : 1432 - 1434
  • [13] Hamid B A, 1994, Hawaii Med J, V53, P10
  • [14] LONG-TERM FOLLOW-UP IN PATIENTS WITH INCESSANT VENTRICULAR-TACHYCARDIA
    HARIMAN, RJ
    HU, DY
    GALLASTEGUI, JL
    BECKMAN, KJ
    BAUMAN, JL
    [J]. AMERICAN JOURNAL OF CARDIOLOGY, 1990, 66 (10) : 831 - 836
  • [15] NONPARAMETRIC-ESTIMATION FROM INCOMPLETE OBSERVATIONS
    KAPLAN, EL
    MEIER, P
    [J]. JOURNAL OF THE AMERICAN STATISTICAL ASSOCIATION, 1958, 53 (282) : 457 - 481
  • [16] KLUGER J, 1995, PACE, V18, P845
  • [17] KOHNO J, 1995, PACING CLIN ELECTROP, V18, P846
  • [18] INCESSANT VENTRICULAR-TACHYCARDIA ASSOCIATED WITH CONGESTIVE-HEART-FAILURE
    KOLETTIS, TM
    THEODORAKIS, GN
    LIVANIS, E
    ZARVALIS, E
    PARASKEVAIDIS, I
    KREMASTINOS, DT
    [J]. PACE-PACING AND CLINICAL ELECTROPHYSIOLOGY, 1995, 18 (11): : 2096 - 2099
  • [19] RADIOFREQUENCY CATHETER ABLATION OF SUSTAINED VENTRICULAR-TACHYCARDIA IN IDIOPATHIC DILATED CARDIOMYOPATHY
    KOTTKAMP, H
    HINDRICKS, G
    CHEN, X
    BRUNN, J
    WILLEMS, S
    HAVERKAMP, W
    BLOCK, M
    BREITHARDT, G
    BORGGREFE, M
    [J]. CIRCULATION, 1995, 92 (05) : 1159 - 1168
  • [20] EFFECT OF ANTIARRHYTHMIC DRUG-THERAPY ON THE INCIDENCE OF SHOCKS IN PATIENTS WHO RECEIVE AN IMPLANTABLE CARDIOVERTER DEFIBRILLATOR AFTER A SINGLE EPISODE OF SUSTAINED VENTRICULAR-TACHYCARDIA FIBRILLATION
    KOU, WH
    KIRSH, MM
    BOLLING, SF
    STIRLING, M
    KADISH, AH
    DEBUITLEIR, M
    CALKINS, H
    LEWIS, RRR
    MORADY, F
    [J]. PACE-PACING AND CLINICAL ELECTROPHYSIOLOGY, 1991, 14 (11): : 1586 - 1592