植入型心律转复除颤器治疗Brugada综合征五例随访  

Follow-up of five patients with Brugada syndrome with a cardioverter defibrillator implanted

作　　者：袁斌斌[1] 杨兵[1] 单其俊[1] 陈明龙[1] 邹建刚[1] 徐东杰[1] 陈椿[1] 李库林[1] 曹克将[1] 

机构地区：[1]南京医科大学第一附属医院心血管内科,硕士研究生210029

出　　处：《中华心律失常学杂志》2006年第4期286-289,共4页Chinese Journal of Cardiac Arrhythmias

基　　金：江苏省教委基金(04KJB310087);南京医科大学创新基金(CX2003015);南京医科大学基金(NY200031)

摘　　要：目的报道5例植入型心律转复除颤器(ICD)的Brugada综合征患者的随访结果。方法5例隐匿性Brugada综合征男性患者,平均年龄(41．60±10．14)岁,植入单腔ICD后每3个月临床随访1次,体外程控分析ICD记录的各种心律失常发作的时间、类型、治疗方式和结果。结果4例患者经钠通道阻滞剂激发试验确诊,另1例经新胸导联检查确诊(该例的诊断参考了单其俊等“新胸导联”标准作出的诊断,是否恰当有待于其他组学者的研究证实)。5例患者植入ICD前均反复发作晕厥,其中4例记录到心室颤动(室颤),3例电生理检查诱发出室颤。平均随访(22±18)个月ICD共记录到75次室颤发作,其中61次室颤触发ICD 86次放电,均成功转复窦性心律；其余14次室颤自行终止。例1出现除颤阈值增高,仍有4次短暂的晕厥发作；例4因房颤导致26次ICD误放电,经程控调整后未再发生；例5有2次晕厥发作但无ICD相关事件记录,直立-倾斜试验阳性,考虑合并血管迷走性晕厥。结论ICD是高危的Brugada综合征患者必要的和有效的治疗措施,但可能出现除颤阈值增高或误放电,应严密随访并进行合理的程控。Objective To follow up clinical symptoms, episodes of arrhythmia and its therapy in patients with Brugada syndrome treated with implantable cardioverter defibrillator（ICD）. Methods Five patients with concealed Brugada syndrome[all male, mean age（41.60±10.14）years）were treated with single-chamber ICD and followed up every three months. By analyzing the electrogram storage of ICD,we got the time of onset, type, treatment and results of arrhythmia episodes. Results The diagnosis of Brugada syndrome was made according to sodium channel blocker provocation test in four patients （2 by ajmaline, 2 by propafenon ） and screen of new precordial leads system in another case. Before implantation of ICD, all of the five patients have recurrent syncope. Ventricular fibrillation （VF） have been recorded in four of them, and also been induced by programmed electrical stimulation （EPS） in three. During a mean follow-up of （22±18 ） months ,75 episodes of VF were documented in 4 patients. Among which,61 episodes were terminated and converted to sinus rhythm by 86 shocks while the other 14 stopped spontaneously. One patient still experienced 4 episodes of syncope due to the defirillation threshold was increased. One patient had 26 inappropriate shocks due to atrial fibrillation, which disappeared after the protocol of ICD was adjusted. Another one who had two episodes of syncope without any relevant events recorded in his ICD was diognosised as vasovagal syncope beeaues of the positive result of tilt table test. Conclusion ICD implantation is a necessary and effective therapy for high risk patients with Brugada syndrome. The patients should be followed up regularly and programmed appropriately beeatse of the increased defibrillation threshold or inappropriate shocks.

关 键 词：BRUGADA综合征 植入型心律转复除颤器 随访 晕厥 

分 类 号：R541.7[医药卫生—心血管疾病]