植入型心房除颤器治疗心房颤动的临床应用  

Management of atrial fibrillation with implantable atrial defibrillator

作　　者：王琼[1] 刘柱柏[2] 谢鸿发[2] 余卓文[2] 李丽芬 梁琛健 

机构地区：[1]解放军第四军医大学西京医院 [2]香港大学玛丽医院心脏内科 [3]香港九龙广华医院

出　　处：《中华心律失常学杂志》2000年第1期11-17,共7页Chinese Journal of Cardiac Arrhythmias

摘　　要：目的　评估植入型心房除颤器 (implantable atrial defibrillator,IAD)治疗阵发性和持续性心房颤动 (房颤 )患者的有效性和安全性。方法　 1 1例患者 (8例阵发性房颤 ,3例持续性房颤 )安装了 IAD,型号 Metrix TM30 0 0和 Metrix TM30 2 0。所有的患者左室功能正常 ,45 %存在高血压等基础心脏病。 IAD在识别房颤和心室同步化后 ,通过右房 -冠状静脉窦电流路线 ,发放低能量 (<6 J)的除颤双相脉冲电流。结果　 1 1例患者全部成功植入 IAD。术后 6个月的随访期内均为窦性心律。 IAD发放近 2 2 6次电击 ,成功地复律93.4%的自发性房颤发作 (99/ 1 0 6 ) ,平均每次房颤发作需 (2 .1± 1 .9)次电击 ,电能约为 4.6 J。所有的电击除颤均未出现致室性心律失常的情况。 37% (3/ 1 1 )的患者可以不用任何麻醉而忍受最多 2次的电击 ,其他患者电击时仅需小量的意识麻醉。　结论　 IAD可以迅速、准确地识别房颤 ,并有效安全地电击复律。Objective To evaluate the clinical efficacy and safety of implantable atrial defibrillator (IAD) in the treatment of patients with paroxysmal and persistent atrial fibrillation (AF). Methods Eleven patients with drug refractory paroxysmal and persistent AF were implanted with an implantable atrial defibrillator (IAD),Metrix TM 3000 and Metrix TM 3020.They all had normal left ventricular ejection fraction.and 45% had underlying heart diseases.Through the RA CS vector,biphasic low energy shocks 3～6 J were delivered after the detection with two algorithms and R wave synchronization. Results All IAD were successfully implanted without severe complications.Over the follow up period of 6 months,all patients remain in sinus rhythm.93 4% of the 106 episodes of spontaneous atrial fibrillation (AF duration 1～384 hours),were promptly cardioverted by IAD with a total of 229 shocks at 280 V,4 6 J.All defibrillation were performed safely without any proarrhythmic events.37% patients (3/11) could tolerate at least 2 shocks without sedation,while the rest needed mild sedation of 1～10 mg midazolam through up to 6 shocks. Conclusion IAD can promptly cardiovert episodes of spontaneous AF in a safe and effective way,and is and effective means in maintaining sinus rhythm.

关 键 词：心房颤动 植入型 心房除颤器 

分 类 号：R541.7[医药卫生—心血管疾病]