植入型心律转复除颤器治疗室性快速心律失常的临床应用  

Clinical application of implantable cardioverter defibrillator (ICD) in treatment of rapid venticular ourhythria

作　　者：蔡飞[1] 陈松[1] 顾刚[2] 吴立群[2] 

机构地区：[1]江苏省南通市第三人民医院心内科,226000 [2]上海交通大学附属瑞金医院心内科

出　　处：《中国介入心脏病学杂志》2009年第2期89-91,共3页Chinese Journal of Interventional Cardiology

摘　　要：目的探讨植入型心律转复除颤器(ICD)对室性快速心律失常的治疗效果以及随访过程中所遇到的问题。方法48例植入ICD患者(其中8例为双腔ICD),根据患者室性心动过速(VT)/心室颤动(VF)发作时的频率及对血流动力学的影响确定方法和参数,并对植入ICD患者定期随访。结果48例患者顺利植入ICD,无并发症,在随访1～38个月中,患者共发作VT/VF 1 025次(VT764次,占74.5%;VF 261次,占25.5%),其中1 009次(98.4%)治疗成功,16次在ICD充电结束前自行终止。764次VT中,658次(86.1%)经抗心动过速起搏(ATP)终止,106次(13.9%)经低能量复律(CV)终止。261次VF中,经高能量除颤(DF)均终止。6例患者发生误放电19次,8例双腔ICD患者无误放电。结论ICD的疗效是确定的。但单腔ICD常会发生误识别、误放电,随访和及时调整参数可避免或减少此类情况发生。双腔ICD提高了对室上性心律失常的识别能力,从而减少误发电。同时应合理应用抗心律失常药物,高度重视ICD患者的心理治疗。Objective To discuss the effect of ICD in treating rapid ventricular arrhythmia and the problems appeared during follow up. Methods Forty-eight patients who had ICD implanted （8 with double chamber ICD） were enrolled in this study. The methods and parameters were decided according to the frequency of ventricular tachyeardia （ VT）/ventricular fibrillation （VF） and the effect on hademodynamies. All the patients were followed up regularly. Results The ICDs were successfully implanted in 48 patients and no severe complication occurred. During the lergth of follow-up varied from 1 to 38 months, 1 009 episodes （98.4%） at of 1 025 VT/VF （ VT 764 74.5% ; VF 261 25.5% ） episodes were successfully treated and 16 episodes stopped spontaneously before the ICD was charged. A total of 658 episodes （86. 1% ） out of 764 VT were stopped by anti- tachycardiac pacing and 106 episodes （13.9%） were stopped by low- energy recovering beat. Two hundred and sixty-one episodes of VF were stopped by high- energy defibrillating fibrillation. Nineteen incorrect discharges of ICD were recorded in 6 patients. All the double chamber ICD discharged correctly. Conclusion Treatment of rapid rentricular arrhythmia with ICD is assurable, however, single chamber ICD may have mistakes in identifying information and discharge incorrectly, which makes follow up and adjustment of parameters in time importast. Double chamber ICD shows better ability in identification of upper- ventrieular arrhythmia thus reducing the rate of incorrect discharge.

关 键 词：除颤器 植入型 心动过速 室性 心室颤动 随访研究 

分 类 号：R654.2[医药卫生—外科学] R541.71[医药卫生—临床医学]