植入式心律转复除颤器受者快速非持续性和持续性室性心动过速的发生率及其与心力衰竭指南指导的药物治疗依从性的相关性

IF 1.7 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Arrhythmia Pub Date : 2025-08-06 DOI:10.1002/joa3.70156

Muhammad Taha Khan, Ghazala Irfan, Sarim Ansari, Zubair Mumtaz, Faisal Qadir, Azam Shafquat

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引用次数: 0

摘要

背景室性心律失常在心力衰竭伴射血分数降低（HFrEF）患者中普遍存在。快速非持续性室性心动过速（RR-NSVT）和持续性室性心动过速（VT）可以在植入式心律转复除颤器（ICD）审讯中检测到，由于区分室上性心动过速和室性心动过速的区分算法。本研究旨在评估ICD询问时RR-NSVT和持续VT的发生率及其与HFrEF指南药物治疗（GDMT）依从性的相关性。方法设计横断面分析研究。设置：巴基斯坦卡拉奇国立心血管疾病研究所电生理科心律装置门诊。参与者：年龄在18岁或以上的HFrEF患者，植入双腔ICD或心脏再同步化治疗除颤器（CRT-D）。结果测量变量包括人口统计学、合并症、药物、GDMT依从性和心律装置参数。采用多变量logistic回归评估RR-NSVT、持续VT的发生率及其与HFrEF GDMT依从性的相关性。结果研究评估了139例患者。男性77.7%。平均年龄56.4±13.9岁。左室射血分数平均值为26.4%±5.5%。109例（78.4%）患者符合GDMT（-受体阻滞剂94.3%，肾素-血管紧张素抑制剂93.5%，醛固酮拮抗剂71.9%，SGLT-2抑制剂15.8%）。54例（38.8%）患者发生了RR-NSVT，其中37例患者尽管遵守了GDMT，但仍发生了RR-NSVT，尽管这种相关性没有统计学意义。12例（8.6%）患者持续VT，这在GDMT依从性患者中明显较少见。结论：尽管HFrEF GDMT符合要求，但超过三分之一的参与者发生了RR-NSVT发作。这些患者也有相关的持续性VT发作，GDMT依从性患者的发生率显著降低。

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Incidence of Rapid Rate Non-Sustained and Sustained Ventricular Tachycardia in Implantable Cardioverter-Defibrillator Recipients and Its Correlation With Heart Failure Guideline-Directed Medical Therapy Compliance

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Background

Ventricular arrhythmias are prevalent among heart failure with reduced ejection fraction (HFrEF) patients. Rapid rate non-sustained ventricular tachycardia (RR-NSVT) and sustained ventricular tachycardia (VT) can be detected on implantable cardioverter-defibrillator (ICD) interrogation due to discrimination algorithms that differentiate supra-ventricular from ventricular tachycardia. This study aims to assess the incidence of RR-NSVT and sustained VT on ICD interrogation and their correlation with HFrEF guideline-directed medical therapy (GDMT) compliance.

Methods

DesignCross-sectional, analytical study. SettingHeart rhythm device clinic, Electrophysiology department, National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan. ParticipantsPatients implanted with dual chamber ICD or cardiac resynchronization therapy defibrillator (CRT-D), aged 18 years or above with HFrEF. Outcome MeasureCovariates included demographics, comorbidities, medications, GDMT compliance, and cardiac rhythm device parameters. Incidence of RR-NSVT, sustained VT, and their correlation with HFrEF GDMT compliance was assessed using multivariate logistic regression.

Results

Study evaluated 139 patients. Men 77.7%. The mean age was 56.4 ± 13.9 years. The mean LV ejection fraction was 26.4% ± 5.5%. 109 (78.4%) were GDMT compliant (94.3% on beta-blockers, 93.5% on renin-angiotensin inhibitors, 71.9% on aldosterone antagonists, and 15.8% on SGLT-2 inhibitors). RR-NSVT episodes were observed in 54 (38.8%) patients, out of whom 37 had RR-NSVT despite GDMT compliance, although this correlation was not statistically significant. Twelve (8.6%) patients had sustained VT, which was significantly less common with GDMT compliance.

Conclusion

More than one-third of participants had RR-NSVT episodes despite HFrEF GDMT compliance. These patients also had associated sustained VT episodes, the occurrence of which was significantly less with GDMT compliance.

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