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

Wessels, Ansgar Wilhelm

Dissertation

Angenommen am: 2016-07-06

Erschienen: 2016-06-21

Betreuer: Zabel, Markus Prof. Dr.

Gutachter: Meyer, Thomas Prof. Dr.

Gutachter: Sigler, Matthias Prof. Dr.

Gutachter: Schön, Margarete Prof. Dr.

Zum Verlinken/Zitieren: http://hdl.handle.net/11858/00-1735-0000-0028-8790-E

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Zusammenfassung

Englisch

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