埋藏式心脏转复除颤器患者的随访  

Follow up of patients with implantable cardioverter defibrillator.

作　　者：蔡彬妮[1] 黄卫斌[1] 王焱[1] 陈超[1] 万发银[1] 周法光[1] 

机构地区：[1]厦门大学附属中山医院厦门心脏中心心内科,福建厦门361004

出　　处：《中国心脏起搏与心电生理杂志》2009年第1期30-33,共4页Chinese Journal of Cardiac Pacing and Electrophysiology

摘　　要：目的报道7例埋藏式心脏转复除颤器(ICD)治疗恶性室性心律失常的情况。方法对6例单腔ICD及1例双腔ICD植入者进行随访,通过ICD程控仪调出储存的资料,了解ICD对恶性心律失常的治疗情况,并对其工作情况进行分析。结果随访5～44个月,平均23.7个月,ICD共检测到持续性室性心动过速(VT)2 129次,心室颤动(VF)6次。采用抗心动过速起搏(ATP)治疗VT的成功率为91.9%,ATP未能终止的VT经低能量转复(CV)治疗95.3%转为窦性心律,少数VT经治疗后加速为VF。高能量除颤(DF)终止VF的成功率为100%。4例12次误将室上性心动过速误判断为室性事件而启动治疗,其中2次心房颤动,10次窦性心动过速,经调整VT的识别参数及联合使用抗心律失常药物后未再发生类似情况。2例随访期间出现晕厥,ICD存储的信息显示发生了VF并复律成功。2例出现焦虑症,经心理治疗改善。结论术后严密随访,及时调整工作参数,同时关注患者的心理健康并给予针对性的心理支持和治疗,对提高ICD的治疗效果至关重要。Objective To assess the efficacy of implantable cardioverter defibrillators （ICD） in treating malignant ven- tricular arrhythmia. Methods Seven patients with ICD were followed up. Among them, six patients received single chamber ICD therapy and one received dual chambers. The stored data was collected from ICD memory , then retrieved and analyzed the information on treating malignant ventricular arrhythmia. Results The mean follow up time was 23.7 months. The storage data revealed that 2 129 episodes of ventricular taehycardia （VT） and 6 episodes of VF were detected 91.9% of VT were terminated by antitachycardia pacing, and 95.3% of the else were terminated by low energy cardiover- sion （CV）. VF were treated by ICD successfully with defibrillation （DF） . Two episodes of atrial fibrillation and l0 epi- sodes of sinus tachycardia in 4 patients were disdetected as VT . After the detection parameters of VT were adjusted and combined with antiarrhythmic drugs, such phenomenon had never taken place during follow up. Two patients developed light postoperative psychological disturbance. Conclusion Careful postoperative observation and reprogramming after spontaneous events are important. Psychological supports and therapies should be done to the patients with ICD. [ Chinese Journal of Cardiac Pacing and Electrophysiology,2009,23 （ 1 ） ：30 - 33 ]

关 键 词：心血管病学 埋藏式心脏转复除颤器 恶性室性心律失常 随访 参数调整 

分 类 号：R318.11[医药卫生—生物医学工程] R541.7[医药卫生—基础医学]