Prevention of sudden cardiac death in patients with ejection fraction reduced heart failure receiving ICD implantation / 中国实用内科杂志

ABSTRACT

OBJECTIVE: By recording the treatment events of implantable cardioverter defibrillator(ICD) in patients with ejection fraction reduced heart failure(HFrEF), to analyze the difference in primary and secondary prevention patients. METHODS: A single center retrospective study was conducted. HFrEF patients with ICD or cardiac resynchronization therapy with cardioverter defibrillator(CRT-D) implanted in Peking Union Medical College Hospital from January 2006 to December 2017 were enrolled in our study. Basic clinical data was collected and ICD treatment events were recorded during follow-up. The appropriate treatment events were identified according to electrocardiogram recorded by ICD. The ICD treatment events of primary and secondary prevention patients were analyzed. RESULTS: 1) A total of 145 patients with HFrEF implanted with ICD or CRT-D were enrolled, 103 primary prevention patients and 42 secondary prevention patients. Primary prevention patients had longer left ventricular end-systolic diameter(LVESD) and lower left ventricular ejection fraction(LVEF) than secondary prevention patients. 2) Multivariate competitive risk regression analysis showed that secondary prevention patients and male patients had higher risk of receiving appropriate treatment and appropriate shock therapy. 3) K-M curve and Log-Rank test showed that there was no significant difference in the risk of inappropriate treatment between primary and secondary prevention patients. The main cause of inappropriate treatment was atrial flutter or atrial fibrillation. CONCLUSION: 1) Primary prevention patients have lower risk of receiving appropriate treatment and appropriate shock therapy than secondary prevention patients; 2) There is no significant difference between primary and secondary prevention patients in the risk of inappropriate treatment. The main cause of inappropriate treatment events is atrial flutter or atrial fibrillation.