Inappropriate Shocks in Patients with Implantable Cardioverter Defibrillator: Demographics and Predictors

Yıl 2017, Cilt: 20 Sayı: 3, 230 - 234, 03.12.2017

Özkan Candan

Öz

Introduction: Inappropriate
ICD shocks may negatively affect the quality of life and lead to arrhythmias
and psychiatric problems. In this study, we investigated demographic and
clinical characteristics of patients with ICD shocks and the predictors leading
to inappropriate ICD shocks presented to our emergency department.

Patients and Methods:
A
total of 64 patients with ICD shocks presented to the emergency department were
included in the study. Clinical data of the patients were retrospectively
obtained. The clinical features, left ventricular ejection fraction (LVEF),
drugs used, and electrocardiographic (ECG) data at the time of implantation of
the patients were obtained.

Results: Of the
patients presented, 82% were male and the mean age was found as 56.6 ± 15.8
years. Fourty-nine (76%) and 15 (34%) patients experienced appropriate and
inappropriate ICD shocks, respectively. The most common findings in the
patients presented with inappropriate ICD shocks included atrial fibrillation
in 8 (53%), supraventricular tachycardia in 6 (40%), and lead sensing problem
in 1 (7%) patients. Compared with the patients presented with appropriate
shocks, patients with inappropriate ICD shocks were younger, had less coronary
artery disease, had more history of atrial fibrillation before implantation,
and shorter time from implantation to first inappropriate shock. In
multivariate logistic regression analysis, age and a history of atrial
fibrillation were found as independent predictors for inappropriate ICD shocks.

Conclusion: Presence of atrial
fibrillation is the most common rhythm problem that causes inappropriate ICD
shocks. History of previous atrial fibrillation and a younger age are
predicting clinical parameters for inappropriate ICD shocks.

Anahtar Kelimeler

Inappropriate ICD shock, atrial fibrillation

İmplante Kardiyoverter Defibrilatör Yapılan Hastalarda Uygunsuz-Şoklama: Demografik Özellikler ve Öngördürücüler

Öz

Giriş: Uygunsuz implante edilen kardiyoverter defibrilatör (ICD) şokları yaşam
kalitesini olumsuz etkileyebilir, aritmiye ve psikiyatrik sorunlara yol
açabilir. Biz çalışmamızda acil servisimize ICD şoklamasıyla başvuran
hastaların demografik, klinik özeliklerini ve uygunsuz ICD şoklamasına yol açan
öngördürücüleri araştırdık.

Hastalar ve
Yöntem: Acil servise ICD şoklamasıyla başvuran 64 hasta
çalışmaya alındı. Hastalara ait klinik veriler retrospektif olarak elde edildi.
Çalışmaya dahil edilen hastaların klinik özelikleri, sol ventrikül ejeksiyon
fraksiyonu (LVEF), kullandıkları ilaçlar, implantasyon anındaki
elektrokardiyogramlarına (EKG) ait veriler elde edildi.

Bulgular: Başvuran hastaların %82’si erkek ve ortalama yaş (56.6 ± 15.8) tespit
edildi. Kırk dokuz (%76) hastada  uygun
şoklama tespit edilirken 15 (%34) hastada uygunsuz ICD şoklaması tespit edildi.
Uygunsuz ICD şoklama ile başvuran 
hastalarda sırasıyla en sık atriyal fibrilasyon (AF) 8 (%53), supraventriküler
taşikardi 6 (%40) ve lead algılama sorunu 1 (%7) hastada  saptandı. Uygunsuz ICD şoklaması olan
hastalar uygun şoklamayla başvuran hastalarla kıyaslandığında daha genç yaşa,
daha az koroner arter hastalığına, implantasyon öncesi  daha fazla AF öyküsüne ve implantasyondan
sonra ilk şoklamaya kadar  daha kısa
süreye sahip olan hastalardı. Multivariate logistik regresyon analizi sonrası
yaş, AF öyküsü varlığı uygunsuz ICD şoklaması için bağımsız öngördürücü olduğu
bulundu.

Sonuç: AF varlığı uygunsuz ICD
şoklamasına neden olan  en sık ritm
sorunudur. Daha önce AF öyküsünün olması ve genç yaşta olmak, uygunsuz ICD
şoklaması için öngördürücü klinik parametrelerdir.

Anahtar Kelimeler

Uygunsuz ICD şoklama, atriyal fibrilasyon

Kaynakça

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