经静脉植入心律转复除颤器的临床应用  

Clinical application of transvenous implantable cardioverter defibrillator

作　　者：柳弘[1] 任学军[1] 张金荣[1] 田锐[1] 

机构地区：[1]北京首都医科大学附属北京安贞医院心内科,100029

出　　处：《心肺血管病杂志》2002年第1期20-21,共2页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的 :应用植入型心律转复除颤器 (ICD)治疗致命性室性心律失常。方法 :4例均为男性 ,年龄 39～ 74岁。 3例冠心病 ,1例扩张型心肌病 ,伴LBBB +I° AVB。药物治疗不佳。 3例冠心病植入单腔ICD ,扩张型心肌病植入双腔ICD。结果 :4例均成功植入ICD。平均起搏阈值 0 4 5v。平均R波振幅15 75mv。随访 8～ 36个月 ,3例出现快频率室速 ,经抗心动过速起搏及低能量电击治疗转复为窦律 ,平均电击能量 5 4J。 1例单腔ICD发生室上性心动过速导致误放电 ,经重新设置室速频率窗口 ,未再出现误放电。结论 :ICD能有效转复恶性室性心律失常 ,双腔ICD因增加了心房电极 ,在改善血液动力学、预防房性及室性快速心律失常 ,降低不适当ICD治疗等方面优于单腔ICD。Objective:Report of using implantable cardioverter defibrillator (ICD) to treat ventricular tachyarrhythmias.Method:There were 4 males aged 39～74 years.Three were coronary heart disease and of which one had anterior myocardial infarction.The other one was dilated cardiomyopathy who was accompanied by LBBB+I°\|AVB.Antiarrhythmic drug therapy was unsuccessful to them.The ICD were implanted transvenously.Three were single\|chamber ICD,one was dual\|chamber ICD.Result:All operations were performed successfully.The average pacing threshold and amplitude of R wave was 0\^45 v and 15\^75mv.In 8～36 months follow\|up,the fast ventricular tachyarrhythmia in three patients was treated by antitachycardiapacing and shock.The average energy was 5\^4J.Fault shock occurred due to superventricular tachycardia in one patient which being converted to sinus rhythm.After reseting it,fault shock disappeared.Conclusion:ICD can convert severe ventricular tachyarrhythmia effectively.The dual\|chamber ICD offers several additional benefits that improves hemodynamic,prevents atrial or ventricular tachyarrhythmias,decreases inappropriate ICD therapy.

关 键 词：植入型心律转复除颤器 室性快速心律失常 心脏性猝死 ICD 

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