Tom 14, Nr 2 (2019)
Praca badawcza (oryginalna)
Opublikowany online: 2019-05-22
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Obserwacja długoterminowa u pacjentów z wszczepialnym kardiowerterem- -defibrylatorem i poddanych terapii resynchronizującej oraz bez niej
DOI: 10.5603/FC.2019.0032
Folia Cardiologica 2019;14(2):136-141.
Streszczenie
Wprowadzenie. Wszczepialny kardiowerter-defibrylator (ICD) z terapią resynchronizującą (CRT-D) oraz bez niej stanowi efektywny element leczenia u pacjentów z niewydolnością serca.
Metody i wyniki. Sześćdziesięciu pacjentów (50/60; 83,33% mężczyzn) pozostających pod opieką kliniki kardiologii w la- tach od maja 1995 roku do lutego 2019 roku z wszczepionym ICD/CRT-D, u których wykonano przynajmniej jedną wy- mianę urządzenia, poddano retrospektywnej analizie. Kobietom rzadziej wszczepieniu zarówno ICD, jak i CRT-D niż męż- czyznom (9/26 kobiet w grupie z ICD oraz 1/24 w grupie z CRT-D [p = 0,035], iloraz szans [OR] 8.31 95-proc. przedział ufności [CI] 0,98–70,56). Panie charakteryzowały się wyższą frakcją wyrzutową lewej komory (LVEF) (38,11 ± 12,74% v. 29,65 ± 12,63 [p = 0,027]). U opisywanych chorych CRT-D wszczepiano głównie w ramach w prewencji pierwotnej (22/25 v. 18/35 [p = 0,0726], OR 6,93 95% CI 1,75–27,43) oraz u pacjentów z niższą LVEF niż u osób z ICD (24,75 ± 8,98 v. 35,52 ± 13,55%; p = 0,001). Analiza parametrów technicznych elektrod endokawitarnych wykazała obniżenie oporności, gdy porównano parametry z dnia wszczepienia i ostatniej wizyty kontrolnej. W grupie z wszczepionym ICD oporność elektrod przedsionkowych wynosiła 280,03 ± 335,3 w porównaniu z 218,29 ± 229,48 omów (p = 0,0018), a elektrod defibrylujących 768,66 ± 210,62 w porównaniu z 507,03 ± 131,67 omów (p < 0,001) (dzień implantacji v. ostatnia kontrola). W grupie poddanych CRT-D średnia oporność elektrod przedsionkowych wynosiła 511,05 ± 271,30 w porównaniu z 388,55 ± 231,75 omów (p = 0,007), elektrod defibrylujących 698,95 ± 165,45 w porównaniu z 547,13 ± 385,24 omów (p = 0,002), a elektrod lewokomorowych 1036,28 ± 337,34 w porównaniu z 794,87 ± 274,99 omów (p < 0,001), gdy porównano dzień implantacji z dniem ostatniej kontroli.
Wnioski. Kobiety podlegają terapii resynchronizującej znacznie rzadziej niż mężczyźni. Ponadto CRT-D poddano pacjen- tów z niższą LVEF, głównie w ramach prewencji pierwotnej. Oporność wszystkich elektrod ulegała obniżeniu z upływa- jącym czasem.
Słowa kluczowe: terapia resynchronizującaCRTwszczepialny kardiowerter-defibrylatorICDniewydolność sercaoporność elektrod
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