递延密度泛函理论在心脏再同步治疗时间的测试与长期贫困的结果

Deferred DFT testing at the time of cardiac resynchronization therapy is associated with poor long term outcome Grace Lin, MD, Peter A. Brady, MD, David L. Hayes, MD Mayo Clinic, Rochester, MN USA Background Defibrillation threshold (DFT) testing is commonly performed at the time of ICD implantation In some cases DFT testing may not be performed, or deferred to a later date Impact of no or deferred DFT testing on outcome is unknown Background No or deferred DFT testing: Inadequate anticoagulation Hemodynamic instability Physician discretion Likelihood of no or deferred DFT testing may be higher in patients undergoing cardiac resynchronization therapy (CRT) Background Prevalence and reasons of no or deferred DFT testing in patients undergoing CRT are unknown Outcome of CRT patients who undergo DFT testing vs. those who do not is unknown Methods All CRT-D implants from 1999-2004 at Mayo Clinic Review of Clinical record Operative note ICD database Clinical follow up via questionnaire Methods DFT+ DFT testing at implant DFT- DFT testing not at implant Delayed DFT Subsequent DFT testing DFT- never No subsequent DFT testing Definitions Results 277 CRT-D implants 14 pts lost to follow up 263 pts included 192 DFT+ (tested) 71 DFT (deferred) Device Implants 1999-2004 Results DFT + DFT - p value Age 67 +/- 11 70 +/- 12 0.07 Male 166 (86%) 62 (87%) 1 EF 21% +/- 6 20% +/- 8 0.46 Ischemic CM 136 (71%) 57 (80%) 0.12 NICM 56 (29%) 14 (20%) 0.12 Creatinine 1.6 g/dL +/- 0.8 1.6 g/dL +/- 0.7 0.38 Fluoroscopy Time 42.7 min +/- 23.9 52.1 min +/- 32.9 0.11 Baseline Characteristics Results Reasons for DFT- Inadequate anticoagulation 18 (25%) Severe CAD/ CHF 13 (18%) Prolonged procedure 11 (15%) Hypotension 8 (11%) Intractable VT/ VF 5 (7%) Chronic RV (ICD) lead 4 (6%) CS lead instability 4 (6%) AAD loading 2 (3%) Results Reasons for DFT- Malignant hyperthermia 1 (1%) Unable to induce VF 1 (1%) Apnea 1 (1%) Electrolyte abnormalities 1 (1%) LV pseudoaneurysm 1 (1%) Survival Months P0.04 CP1207784-1 Survival in DFT + vs. DFT- Death or Transplantation DFT+ DFT- Results 71 DFT - 37 subsequent DFT testing 34 no subsequent DFT testing Results Delayed DFT DFT - never p value Age 73 +/- 11 68 +/- 13 0.03 Male 31 (84%) 31 (91%) 0.01 EF 19% +/- 7 21% +/- 8 0.36 Ischemic CM 28 (76%) 29 (85%) 0.01 NICM 9 (24%) 5 (15%) 0.01 Creatinine 1.8 g/dL +/- 0.8 1.4 g/dL +/- 0.8 0.02 Fluoroscopy Time 52.5 min +/- 31.7 50.8 min +/- 34.6 0.83 Baseline Characteristics for subsequent DFT testing Results Timing of delayed DFT testing: Mean 3.4 months +/- 5.7 Range of 1 day to 26 months 13 patients tested 1 week after implantation Results Reasons for Delayed DFT Inadequate anticoagulation 10 (27%) Prolonged procedure 8 (21%) Hypotension 5 (14%) Intractable VT/ VF 3 (8%) CS lead instability 3 (8%) AAD loading 2 (5%) Chronic RV lead 2 (5%) Results Reasons for Delayed DFT Unable to induce VF 1 (3%) Electrolyte abnormalities 1 (3%) Apnea 1 (3%) CHF 1 (3%) Results Reasons for DFT- never Physician deferred 22 (65%) Anticoagulation (unable) 5 (17%) Patient deferred 3 (9%) Chronic RV (ICD) lead 3 (9%) Results Physician deferred (23) Severe CAD (12) Anticoagulation (3) Hypotension (3) Prolonged procedure(3) Malignant hyperthermia (1) LV pseudoaneurysm (1) Survival Months P0.001 CP1207784-3 Survival Delayed DFT vs. DFT- Death or Transplantation Delayed DFT DFT- never Survival Months p= 0.5 CP1207784-2 Delayed DFT DFT + Survival DFT + vs. Delayed DFT Death or Transplantation Conclusions Prevalence of no or deferred DFT testing in this population of patients is high (28%) Survival of patients who undergo DFT testing, whether at the time of implant or later, is similar and is significantly better than patients who never undergo DFT testing Conclusions Patients who do not undergo DFT testing at implan