Vorhersagbarkeit von klinischen Ereignissen bei Patienten mit einem implantierbaren Kardioverter-Defibrillator durch Auswertungen aus dem 24-Stunden-Langzeit-EKG

Vorhersagbarkeit von klinischen Ereignissen bei Patienten mit einem implantierbaren Kardioverter-Defibrillator durch Auswertungen aus dem 24-Stunden-Langzeit-EKG

Predictability of clinical events in patients with implantable cardioverter-defibrillator through analysis of 24h-long-term ECG recordings

Ansgar Wilhelm Wessels

Doctoral thesis

Date of Examination: 2016-07-06

Date of issue: 2016-06-21

Advisor: Zabel, Markus Prof. Dr.

Referee: Meyer, Thomas Prof. Dr.

Referee: Sigler, Matthias Prof. Dr.

Referee: Schön, Margarete Prof. Dr.

Persistent Address: http://hdl.handle.net/11858/00-1735-0000-0028-8790-E

Files in this item

Name: Promotion-Final20160613.pdf

Size: 869,1 KB

Format: PDF

View/Open

The following license files are associated with this item:

Creative Commons

Abstract

English

Sudden cardiac death caused by sustained ventricular arrhythmia is the most common cause of death in western industrial nations. The implantation of an implantable cardioverter defibrillator (ICD) is a treatment, which can quit life-threatening arrhythmias effectively. Methods of determining individual risk of life-threatening arrhythmias need to be improved as currently some patients receive ICDs who will never profit from this device. This single-center observational study examined in 150 patients, who according to current indications an ICD was implanted, the prognostic value of common 24h-long-term-ECG risk markers such as ventricular ectopia, heart rate variability, heart rate turbulence, deceleration- and aceleration capacity on clinical outcome. A selection of patients for a particular cardiac condition was not performed. Mean follow-up was 28 ± 12 months. During this period 25 patients died and 20 patients received an appropriate ICD shock. None of the investigated 24h-long-term-ECG risk markers showed a statistically significantly increased risk of achieving the endpoints all cause mortality or occurrence of appropiate ICD shocks regardless of age and sex. Regardless of age and sex the 24h-long-term-ECG risk markers ventricular extrasystoles, nsVT and HRT 1 showed a statistical trend for an increased risk for receiving appropiate ICD shocks. Only the risk marker nsVT showed in multivariate analysis a statistically significantly increased risk for the achievement of a combined end point of all-cause mortality and occurrence of appropiate ICD shocks (HR: 1.91 95% CI: 1.01 to 3.61, p value: 0,05). The size of the examined registry allows only a limited calculation of the predictive value of 24h-long-term-ECG risk markers. Further investigations of the prognostic relevance of 24h-long-term-ECG risk markers for patients with ICD should be realized in larger clinical trials.

Keywords: Sudden cardiac death; implantable cardioverter defibrillator; 24h-long-term-ECG