ĐẶC ĐIỂM RỐI LOẠN NHỊP THẤT VÀ YẾU TỐ LIÊN QUAN Ở BỆNH NHÂN BỆNH TIM THIẾU MÁU CỤC BỘ ĐƯỢC CẤY MÁY KHỬ RUNG TỰ ĐỘNG (ICD) TẠI BỆNH VIỆN CHỢ RẪY

Abstract

Background: Sudden cardiac death remains the leading cause of mortality in patients with ischemic heart disease, especially among those with left ventricular systolic dysfunction. Ventricular arrhythmias, including ventricular tachycardia (VT) and ventricular fibrillation (VF), are the main mechanisms. Implantable cardioverter-defibrillators (ICDs) are effective in preventing sudden cardiac death; however, data on ventricular arrhythmia characteristics and related factors in Vietnamese patients are limited. Objective: To evaluate the characteristics of ventricular arrhythmias and associated risk factors in patients with ischemic heart disease undergoing ICD implantation. Method: A retrospective cohort study of 57 patients aged ≥18 years with ischemic heart disease who underwent ICD implantation for primary or secondary prevention between January 2021 and June 2024. Clinical data, coronary intervention details, ICD parameters, and arrhythmia events were analyzed. Univariate regression analysis identified associated factors. Result: The mean age was 57.7 ± 6.4 years, with 35.1% being female. All patients had prior coronary interventions, mostly involving stenting of two or more vessels. The most commonly affected arteries were LMCA (30.6%), LCx (27.1%), RCA (21.6%), and LAD (20.7%). Median LVEF was 32% [26–39], with 56.1% in NYHA class III. All patients received optimal heart failure therapy, including beta-blockers (86%), MRA (84.2%), ARNI (71.9%), and SGLT-2i (68.4%). During follow-up, 8 patients (14%) experienced 13 life-threatening ventricular arrhythmia events, with a median time to first event of 10.5 months [8–25.8]. Most arrhythmias (11/13) were monomorphic VT (mean rate 173.3 ± 8.2 bpm), treated by antitachycardia pacing (6 cases) or shock (5 cases); VF accounted for 2 events, both successfully treated by ICD shocks. Univariate analysis showed male gender as a significant risk factor (OR = 19.39; 95% CI: 2.171–173.061; p = 0.008), while ARNI therapy was protective (OR = 0.17; 95% CI: 0.036–0.844; p = 0.030). Conclusion: Ventricular arrhythmias occurred early post-ICD implantation, mainly as ventricular tachycardia, and were effectively controlled through proper device programming. Male gender increased arrhythmic risk, while ARNI therapy provided significant protection. These findings emphasize the importance of optimal medical therapy, particularly ARNI, in improving outcomes alongside ICD treatment.