Multivariate Vorhersagbarkeit von ICD-Schocks und Mortalität bei Patienten nach einer ICD-Neuimplantation

Multivariate Vorhersagbarkeit von ICD-Schocks und Mortalität bei Patienten nach einer ICD-Neuimplantation

Risikostratifikation für maligne ventrikuläre Rhythmusstörungen

Multivariate predictability of ICD shocks and mortality in patients after an ICD new implant

Risk assessment for malignant ventricular rhythm disturbances

Hendrik Lercher

Doctoral thesis

Date of Examination: 2016-11-22

Date of issue: 2016-11-03

Advisor: Zabel, Markus Prof. Dr.

Referee: Paul, Thomas Prof. Dr.

Referee: Oppermann, Martin Prof. Dr.

Persistent Address: http://hdl.handle.net/11858/00-1735-0000-002B-7C62-5

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Abstract

English

In this study, the importance of various parameters for the risk assessment in ICD patients discussed in the literature has been investigated. An inhomogeneous collective study was investigated, the basic distribution of which distributes the clinical daily life as best as possible. Only non-invasive markers were considered. These included a TWA test, a signaling ECG, a 24-hour long-term ECG, a digital 12-channel ECG and the collection of data from the pre-medical and medication history. These data were collected in 122 patients immediately before or after ICD implantation. The follow-up period was 592 (± 240) days. Of the (n =) 122 patients included, 11 (9%) died during the observation period. This corresponds to an annual mortality of 6.8%. In 10 patients (8.2%) an adequate shock was registered by the ICD. This corresponds to an annual risk of shock of 6.2%. By means of multivariate Cox analysis it was shown that apoplex, the number of VES in the Holter ECG, decreased (<114 ms) fQRS values in the SAECG and the use of furosemide significantly correlated with increased morality. The number of VES in the Holter ECG as well as the nicotine abortion also correlate with adequate shock delivery, although here only one 90% significance level is reached. The DC category achieved the 95% significance level (p = 0.048) as the only marker for non-eventful survival in the multivariate calculation. In addition, a statistical trend can be observed for the occurrence of nsVT in the Holter ECG and the implantation indication (p = ns) with respect to the event-free survival. However, the TWA measurement, the SAECG and the digital 12-lead ECG do not appear to be able to add additional benefits in the risk assessment. The reason why the LVEF does not have any prognostic significance in this collective group remains ultimately unclear. On the basis of the results of this work, no method can be identified, which in itself has a special prediction potential. However, it appears that the significance of the long-term ECG, especially the presence of VES and nsVT, should be given particular attention in future studies.

Keywords: ICD; sudden cardiac death; SAECG; T wave alternans; Electrocardiography; Implantable cardioverter defibrillator (ICD); risk assessment; Signal-averaged electrocardiogram; Holter monitor; predicting adverse cardiac events; ICD shock

Schlagwörter: ICD; plötzlicher Herztod; T-Wellen-Alternans (TWA); Spätpotentialmessung (EKG); Langzeit-EKG; Risikostratifikation; Implantierbarer Kardioverter-Defibrillator (ICD); Herzrhythmusstörung; ICD-Schock