| Background: Chronic heart failure(CHF)is the advanced end-stage of cardiovascular disease(CVD)as well a common disease in clinic.There are numerous patients suffered from heart failure at domestic and abroad,laying a huge economic burden on the society and country,the treatment of heart failure is needed comprehensive and difficult at the same time.In addition to classic medical treatment,device therapy has flourished during this year,and cardiac resynchronization therapy(CRT)has been an important non-pharmacological treatment for chronic heart failure,it has been development for the last 30 years.The CRT using in the treatment of chronic heart failure is becoming more and more mature,and it is also one of the focuses of clinical research.Fetal ventricular arrhythmia is one of the important causes of death in cardiovascular diseases.Its pathogenesis and development have not yet been fully elucidated.Except for the antiarrhythmic drugs and catheter ablation for arrhythmias,the implantable cardioverter defibrillators(ICD)play an important part in preventing the refractory arrhythmias from sudden cardiac death.Combined ICD and CRT,it can reduce the risk of sudden cardiac death(SCD)further while improving heart function in patients with heart failure.Objective: Patients with heart failure have improved synchrony,improved cardiac function and activity tolerance,and their long-term clinical prognosis is improved compared with CRT.However,it is undeniable that there are still some unresponsive patients in CRT,and there is still arrhythmia events in CRT responders,especially the ventricular arrhythmias and those can still benefit from ICD therapy.There are different predictors for the ventricular arrhythmia risk in patients post CRT implantation.This study was conducted to analyze the occurrence of postoperative arrhythmias in CRT-D patients with heart failure,and to explore the predict value of the change in left ventricular ejection fraction after implantation for long-term arrhythmia risk.Methods: This study was a retrospectively analyzed.People selected from January 2014 to August 2016,who had been admit to Anhui Provincial Hospital and been diagnose as chronic systolic heart failure.Those were still suffering from heart failure after standard-optimized drug therapy.NYHA II-IV,QRS duration ? 130 ms,had baseline LVEF ? 35%.The baseline data of all patients were collected.All patients completed the preoperative and postoperative ultrasound cardiogram collection.All people were divided into case group and control group according ventricular arrhythmia events at the end of follow-up.Results: A total of 210 patients were included in the analysis,with an average follow-up of 18.0 ± 4.7 months.The average age of patients was 58.9 ± 10.1 years,of which males accounted for 68.1%.Preliminary analysis suggests that the risk of ventricular arrhythmia is related to the ratio of LBBB,primary prevention,etiology of cardiomyopathy,and atrial fibrillation.Multivariate logistic regression analysis indicated that ischemic cardiomyopathy,ICD primary prevention and LBBB were independent risk factors for VA after CRT-D and lower(35)LVEF is also an independent predictor for VA risk after CRT implantation(OR=0.879,95% CI: 0.825-0.936,p < 0.001).The receiver operator characteristic curve(ROC)suggested that postoperative(35)LVEF<11% was able to predict the occurrence of VA events in patients with a specificity of 64.67% and a sensitivity of 74.42%.Subgroup analysis suggested that VA events or all-cause death or readmission risk in patients with(35)LVEFF<11% were higher than those with(35)LVEFF?11%.Conclusion: After cardiac resynchronization therapy,there is an increasement in LVEF,a reduction of the long-term ventricular risk,and a decline in the risk of readmission or all-cause death.Postoperative ?LVEF<11% can be used as an indicator to predict the risk of long-term arrhythmia in patients with CRT. |
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