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埋藏式心脏复律除颤器治疗恶性室性心律失常的随访观察 |
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华伟 王方正 陈新
摘要 对22例埋置了埋藏式心脏复律除颤器(ICD)的有晕厥史的恶性室性心律失常患者进行了随访，观察ICD的治疗效果。22例中扩张型心肌病8例、肥厚型心肌病2例、冠心病7例、QT延长综合症1例，4例未发现器质性心脏病。所有患者均经临床证实有室性心动过速或(和)心室颤动(VT/VF)发作。ICD具有多项治疗及信息储存记忆功能(即第三代)。随访时通过体外程控仪调出ICD储存的资料进行分析。平均随访7.1(1～23)个月，11例患者(50.0%)VT/VF发作118次，其中54次为非持续性VT，均自行终止；接受ICD治疗的64次为VT/VF发作，45次为VT，22次由ICD的抗心动过速起搏(ATP)终止、16次由低能量(2～15 J)转复终止、2次发作为窦性心动过速(误判为VT)，其余5次VT在ATP治疗过程中加速转为VF，由高能量除颤终止。ICD诊断的VF发作共有19次，发生于4例患者，有1例患者接受除颤16次，4次系为频率超过VF感知频率的VT。19次发作均被ICD有效除颤终止。2例扩张型心肌病患者，1例术后3个月死于心功能衰竭，另1例术后2个月反复发作VF，多次接受ICD除颤治疗，最后死于心功能衰竭。结果表明常规进行随访和设定合适的诊断和治疗参数，对提高ICD的治疗效果至关重要。
关键词 心脏复律除颤器，埋藏式 随访 心律失常，室性
The Clinical Follow-up of Patients With Implantable Cardioverter-Defibrillators
Hua Wei,Wang Fangzheng,Chen Xin
(Department of Clinical Electrophysiology,Fuwai Hospital,Chinese Academy of
Medical Sciences,Beijing,100037)
Abstract Twenty-two patients,male 19 and female 3,mean age of 48.95 years were implanted nonthoracotomy implantable cardioverter-defibrillator (ICD) systems.The indication for implantation was ventricular fibrillation (VF) in 14 patients and refractory ventricular tachyarrhythmia (VT) in 8 patients.All patients had syncope out of hospital.The device is the third generation ICD with multitherapies including antitachycardia pacing (ATP),cardioversion,defibrillation and data storing function.In the follow-up of 7.1(1～23) months,11 out of 22 patients (50%) received ICD therapy.The data stored in ICD showed that there were total 118 episodes detected by the devices.54 of them were nonsustained VT which spontaneously terminated.64 VT/VF episodes were treated by ICD.45 of them were VT,22 were terminated by ATP and 16 by low energy cardioversion.2 episodes were sinus tachycardia.Another 5 VT were accelerated to VF and terminated by high energy shocks.There were 19 VF episodes diagnosed by the devices,however 4 of them were confirmed VT which rate over VF detection criterion by reviewed stored electroc[1] [2] 下一页
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