法洛四联症患者行有创性心律失常治疗的临床特点

Barbara Adelmann de Lima, A. C. B. da Silva, M. A. L. Saffi, Clóvis Fröemming Junior, Gabriela Castilhos, M. Kruse, G. D. de Lima, T. Leiria
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引用次数: 0

摘要

引言:法洛四联症(TOF)是一种发绀型先天性心脏病,每年心源性猝死的发生率为0.2%,心律失常是其发生的主要原因。目的:比较接受电生理学研究(EPS)的TOF患者与未接受电生理研究(无EPS)的患者的特征。方法:对215名在2009-2020年间接受EPS治疗的TOF校正患者(中位三年,0.33至51岁)(57.2%男性;年龄=29±4)进行回顾性队列研究。主要转归包括死亡、植入式心脏除颤器(ICD)需求和住院治疗。结果:晕厥前(EPS=4.7%,无EPS=0%;p=0.004)、晕厥(EPS=7.1%,无EPS=1.7%;p=0.056)和心悸(EPS=31%,无EPS=5.8%;p<0.001)是电生理检查的合理症状。在24%的EPS和0.6%的无EPS中植入了ICD(p=0.001)。26%的EPS组出现非持续性室性心动过速,而在无EPS中为0%(p=0.012)。EPS组有更多的心房颤动或心房扑动(35.7%对6.9%;p<0.001)。EPS患者的QRS持续时间比无EPS组宽(171.12±29.52 ms对147±29.77 ms;p<0.001)。此外,26.2%的EPS进行了消融术以纠正大折返性房性心动过速。与无EPS组相比,EPS组患者的主要转归(死亡+ICD需求+住院)发生率更高(p=0.001)。然而,在临床随访期间共有7例死亡,但两组之间没有差异(EPS=4.7%与无EPS=2.8%;p=0.480)。结论:EPS组的心脏病风险更大,更复杂,与无EPS组相比,主要结果的发生率更高。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Clinical Characteristics of Patients with Tetralogy of Fallot who Underwent an Invasive Procedure for Arrhythmias
Introduction: Tetralogy of Fallot (TOF) is a cyanotic congenital heart disease that has an incidence of sudden cardiac death of 0.2% per year, being arrhythmias the main cause of its occurrence. Objective: To compare characteristics of TOF patients referred for electrophysiological study (EPS) against those that were not (No-EPS). Method: Retrospective cohort with 215 patients (57.2% men; age = 29 ± 4) with corrected TOF (median of three years, ranging from 0.33 to 51) that underwent EPS between 2009-2020. The primary outcome was composed of death, implantable cardiac defibrillator (ICD) requirement and hospitalization. Results: Pre-syncope (EPS = 4.7%, No-EPS = 0%; p = 0.004), syncope (EPS = 7.1%, No-EPS = 1.7%; p = 0.056) and palpitations (EPS = 31%, No-EPS = 5.8%; p < 0.001) were symptoms that justified electrophysiological investigation. ICD was implanted in 24% of EPS and 0.6% of No-EPS (p=0.001). Twenty-six percent of the EPS group presented non-sustained ventricular tachycardia, while 0% in No-EPS (p = 0.012). The EPS group had more atrial fibrillation or atrial Flutter (35.7% vs. 6.9%; p < 0.001). The EPS patients had a wider QRS duration than the no-EPS group (171.12 ± 29.52 ms vs. 147 ± 29.77 ms; p < 0.001). Also, 26.2% of EPS performed ablation to correct macroreentrant atrial tachycardias. The incidence of primary outcome (death + ICD requirement + hospitalization) was higher in patients in the EPS group compared to the No-EPS group (p = 0.001). However, the total of seven deaths occurred during the clinical follow-up, but without differences between the groups (EPS = 4.7% vs. No-EPS = 2.8%; p = 0.480). Conclusion: EPS group had a profile of greater risk, more complex heart disease, and a greater occurrence of the primary outcome when compared to the No-EPS group.
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