Long-Term Follow-Up of Patients With Tetralogy of Fallot and Implantable Cardioverter Defibrillator: The DAI-T4F Nationwide Registry.
Обработка статьи · этапы, ошибки и управление
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Waldmann Victor, Bouzeman Abdeslam, Duthoit Guillaume, Koutbi Linda, Bessiere Francis, Labombarda Fabien, Marquié Christelle, Gourraud Jean Baptiste, Mondoly Pierre, Sellal Jean Marc, Bordachar Pierre, Hermida Alexis, Anselme Frédéric, Asselin Anouk, Audinet Caroline, Bernard Yvette, Boveda Serge, Bru Paul, Bun Sok Sithikun, Clerici Gael, Da Costa Antoine, de Guillebon Maxime, Defaye Pascal, Elbaz Nathalie, Eschalier Romain, Garcia Rodrigue, Guenancia Charles, Guy-Moyat Benoit, Halimi Franck, Irles Didier, Iserin Laurence, Jourda François, Ladouceur Magalie, Lagrange Philippe, Laredo Mikael, Mansourati Jacques, Massoulié Grégoire, Mathiron Amel, Maury Philippe, Messali Anne, Narayanan Kumar, Nguyen Cédric, Ninni Sandro, Perier Marie-Cécile, Pierre Bertrand, Pujadas Penelope, Sacher Frédéric, Sagnol Pascal, Sharifzadehgan Ardalan, Walton Camille, Winum Pierre, Zakine Cyril, Fauchier Laurent, Martins Raphael, Pasquié Jean Luc, Thambo Jean Benoit, Jouven Xavier, Combes Nicolas, Marijon Eloi, DAI-T4F Investigators*
Аннотация
METHODS: A Nationwide French Registry including all patients with tetralogy of Fallot with an ICD was initiated in 2010 by the French Institute of Health and Medical Research. The primary time to event end point was the time from ICD implantation to first appropriate ICD therapy. Secondary outcomes included ICD-related complications, heart transplantation, and death. Clinical events were centrally adjudicated by a blinded committee.
RESULTS: A total of 165 patients (mean age, 42.2±13.3 years, 70.1% males) were included from 40 centers, including 104 (63.0%) in secondary prevention. During a median (interquartile range) follow-up of 6.8 (2.5-11.4) years, 78 (47.3%) patients received at least 1 appropriate ICD therapy. The annual incidence of the primary outcome was 10.5% (7.1% and 12.5% in primary and secondary prevention, respectively; P=0.03). Overall, 71 (43.0%) patients presented with at least 1 ICD complication, including inappropriate shocks in 42 (25.5%) patients and lead dysfunction in 36 (21.8%) patients. Among 61 (37.0%) patients in primary prevention, the annual rate of appropriate ICD therapies was 4.1%, 5.3%, 9.5%, and 13.3% in patients with, respectively, 0, 1, 2, or ≥3 guidelines-recommended risk factors. QRS fragmentation was the only independent predictor of appropriate ICD therapies (hazard ratio, 3.47 [95% CI, 1.19-10.11]), and its integration in a model with current criteria increased the 5-year time-dependent area under the curve from 0.68 to 0.81 (P=0.006). Patients with congestive heart failure or reduced left ventricular ejection fraction had a higher risk of nonarrhythmic death or heart transplantation (hazard ratio, 11.01 [95% CI, 2.96-40.95]).
CONCLUSIONS: Patients with tetralogy of Fallot and an ICD experience high rates of appropriate therapies, including those implanted in primary prevention. The considerable long-term burden of ICD-related complications, however, underlines the need for careful candidate selection. A combination of easy-to-use criteria including QRS fragmentation might improve risk stratification. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03837574.