植入型心律转复除颤器在遗传性心律失常患者中的应用及术后随访  

Implantable cardioverter defibrillator in patients with inherited cardiac arrhythmias

作　　者：陈旭华[1] 王靖[1] 丁立刚[1] 浦介麟[1] 楚建民[1] 华伟[1] 张澍[1] 

机构地区：[1]中国医学科学院心血管病研究所北京协和医学院阜外心血管病医院心律失常中心,100037

出　　处：《中华心律失常学杂志》2012年第3期176-179,共4页Chinese Journal of Cardiac Arrhythmias

摘　　要：目的了解因遗传性心律失常植入心律转复除颤器（ICD）的患者术后情况及ICD的治疗效果。方法回顾性分析阜外医院从2004年6月到2011年6月诊断为长QT综合征、Brugada综合征、致心律失常性右心室心肌病（ARVC）以及肥厚型心肌病并且植入了ICD的全部患者，通过定期随访及调阅患者的ICD内存储的数据了解患者术后的一般情况、ICD植入术后室性心律失常的发作情况以及ICD的工作情况。结果共入选患者43例，其中男25例，女18例，年龄8—78（41．5±15．8）岁，随访8～84（37．0±20．6）个月。21例（48．8％）患者在随访期内发生室性心动过速／心室颤动（室速／室颤）事件，其中有5例（11．6％）患者发生的室速／室颤事件属于不恰当识别。1例患者在植入ICD后发生未识别事件。ICD共记录到室速／室颤事件382次，植入ICD后首次发生室速／室颤事件的时间为术后1～36（6．4±8．9）个月，84．6％的室速／室颤事件发生于1年内。ICD共启动治疗程序498次，包括抗心动过速起搏381次，同步电复律83次，高能量除颤34次。结论遗传性心律失常患者恶性室性心律失常复发率高且复发早。二级预防植入ICD可有效预防患者猝死的发生。Objective To investigate the efficacy of implantable cardioverter defibrillator（ICD） in patients with inherited cardiac arrhythmias. Methods A retrospective analysis was conducted in patients with Long-QT syndrome （LQTS）, Brugada syndrome, hypertrophic cardiomyopathy and arrhythmogenic right ventricular cardiomyopathy （ARVC） who received ICDs between June 2004 and June 2011 in Fuwai Hospital. Results Fourty-three patients （58% male, age 41.5 ± 15.8 years）were included. During the follow-up period of （37.0±20. 6） months, a total of 382 episodes of malignant ventricular arrhythmias were documented in 21 patients （48.8%） ,while 5 （11.6%）of whom due to inappropriate detection. One patient had a sustained ventricular tachycardia episode undetected but not leading to a severe event. The average duration from implantation to first malignant ventricular arrhythmias episode was 6.4±8. 9 months. The cumulative event rate was 84. 6% at 1 year follow-up. ICDs delivered 4-98 therapies, consisting of 381 times of ATP, 83 times of CV, and 34 times of SHOCK. Conclusions Patients with inherited cardiac arrhythmias have a high recurrence rate of ventricular malignant arrhythmias, and ICD is effective in preventing these patients from sudden cardiac death. However, inappropriate detection/therapy is an outstanding problem in this population.

关 键 词：植入型心律转复除颤器 心脏性猝死 随访 离子通道病 心肌病 

分 类 号：R541.7[医药卫生—心血管疾病]