置入型心律转复除颤器52例术中除颤阈值的测定及术后随访  

Safety and efficacy of intraoperative defibrillation threshold measured by defibrillation safety margin in 52 patients with implantable cardioverter defibrillator

作　　者：张宇[1] 袁宽道[1] 汤宝鹏[1] 马依彤[1] 张燕一[1] 王疆[1] 李晋新[1] 张疆华[1] 许国军[1] 

机构地区：[1]新疆医科大学第一附属医院心脏中心,乌鲁木齐830054

出　　处：《中华心血管病杂志》2010年第11期975-978,共4页Chinese Journal of Cardiology

摘　　要：目的 探讨置入型心律转复除颤器（ICD）置入术中除颤阈值（DFT）的测定方法并观察术后随访结果.方法 52例置入ICD患者,其中单腔ICD 25例（48.08%）,双腔ICD 23例（44.23%）,三腔ICD 4例（7.69%）.置入术中用测定除颤安全范围（DSM）方法进行DFT测定,并对患者进行定期随访.结果 52例ICD置入术中,测得DFT为（13.27±2.95）J,DSM为（17.40±2.89）J,手术中无严重并发症发生.52例中,38例出现恶性室性心律失常,其中469次为非持续性（可自行终止）室性心动过速（VT）,持续性VT发作265次;经抗心动过速起搏治疗1阵转复成功245次（92.45%）,2阵转复成功13次（4.91%）,抗心动过速起搏治疗转复未成功经电转复7次（2.64%）,均经低能量电转复成功.心室颤动（VF）发作141次均成功识别,其中14次在释放治疗前VF自行终止.127次VF经电除颤治疗,经电除颤治疗1次成功116次（91.34%）,除颤能量为（12.84±3.18）J,2次成功11次（8.66%）,除颤能量为（16.36±2.34）J.结论 应用DSM测定进行ICD置入术中DFT测定安全可行.Objective To observe the safety and efficacy of implantable cardioverter defibrillator （ICD） intraoperative defibrillation threshold （DFT） measured by defibrillation safety margin （DSM）.Methods Fifty-two patients underwent ICD implantation were enrolled in this study （25 single chamber ICD, 23 double chamber ICD, 4 three chamber ICD）. DFT was measured by DSM method. All patients were followuped regularly. Results DFT was （ 13.27 ± 2. 95 ） J and DSM was （ 17. 40 ± 2. 89 ） J in this patient cohort. There were no serious intraoperative complications. Malignant ventricular arrhythmia occurred in 38 patients post ICD, 469 episodes of nonsustained ventricular tachycardia （VT） were spontaneously terminated, 265 episodes were sustained VT and 245 （92. 5% ） episodes were successfully terminated by 1 antitachycardia pace treatment （ATP）, 13（4. 89% ） episodes successfully terminated by 2 ATP, and ATP failed to terminate VT in 7 （2. 64% ） episodes and VTs were terminated by low energy cardioversion. All 141 episodes of ventricular fibrillation （VF） were successfully identified, and 14 episodes spontaneously terminated before discharging, 127 VF episodes （91.34%） were terminated by 1 energy shock,defibrillation energy was （ 12. 84 ±3. 18）J, 11 （ 12.2% ） VF episodes were terminated by 2 energy shocks,defibrillation energy was （ 16. 36 ± 2. 34）J. Conclusion It is safe and feasible to use defibrillation threshold measured by DSM for patients receiving ICD implantation.

关 键 词：心脏起搏 人工 心动过速 室性 心室颤动 治疗结果 

分 类 号：R686[医药卫生—骨科学]