Abstract

Objectives

Implantable cardiac devices are common in patients with tetralogy of Fallot (ToF) (18.3–21.3%) according to previous reports from large centres. We conducted this study to investigate the prevalence and incidence of cardiac devices in a less selected population of patients with ToF and assess factors other than arrhythmia associated with having a device. Design: 530 adult (≥18 years) patients with repaired ToF were identified in the national registry of congenital heart disease (SWEDCON) and matched with data from the Swedish pacemaker registry. Patients with implantable cardiac devices were compared with patients without devices. Results: Seventy-five patients (14.2%) had a device; 51 (9.6%) had a pacemaker and 24 (4.5%) had an implantable cardioverter defibrillator. The incidence in adult age (≥18 years) was 5.9/1000 patient years. Estimated device free survival was 97.5% at twenty, 87.2% at forty and 63.5% at sixty years of age. Compared with previous studies, the prevalence of devices was lower, especially for ICD. In multivariate logistic regression, cardiovascular medication (odds ratio [OR] 3.5, 95% confidence interval [CI] 1.8–6.8), impaired left ventricular function, (OR 2.6, 95%CI 1.3–5.0) and age (OR 1.02, 95%CI 1.002–1.05) were associated with having a device. Conclusion: The prevalence of devices in our population, representing a multicenter register cohort, was lower than previously reported, especially regarding ICD. This can be due to differences in treatment traditions with regard to ICD in this population, but it may also be that previous studies have reported selected patients with more severe disease.

中文翻译：

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修复法洛四联症成年患者的植入式心脏装置

摘要

目标

根据大型中心先前的报告，植入式心脏装置在法洛四联症 (ToF) 患者中很常见（18.3-21.3%）。我们进行了这项研究，以调查较少选择的 ToF 患者中心脏装置的流行率和发生率，并评估与使用装置相关的心律失常以外的其他因素。设计：在国家先天性心脏病登记处 (SWEDCON) 中确定了 530 名 ToF 修复的成人（≥18 岁）患者，并与瑞典起搏器登记处的数据相匹配。将植入式心脏装置的患者与没有装置的患者进行比较。结果：75 名患者 (14.2%) 拥有设备；51 人 (9.6%) 有起搏器，24 人 (4.5%) 有植入式心脏复律除颤器。成年年龄（≥18 岁）的发病率为 5.9/1000 患者年。20 岁时估计无器械生存率为 97.5%，40 岁时为 87.2%，60 岁时为 63.5%。与之前的研究相比，设备的普及率较低，尤其是 ICD。在多元逻辑回归中，心血管药物（优势比 [OR] 3.5，95% 置信区间 [CI] 1.8-6.8）、左心室功能受损（OR 2.6，95%CI 1.3-5.0）和年龄（OR 1.02、95 %CI 1.002–1.05) 与拥有设备有关。结论：代表多中心注册队列的我们人群中器械的流行率低于之前报告的，尤其是在 ICD 方面。这可能是由于该人群中 ICD 的治疗传统存在差异，但也可能是之前的研究报告了某些疾病更严重的患者。