心脏性猝死一级预防患者埋藏式心脏转复除颤器植入后的随访研究  

Follow-up analysis of implantable cardioverter defibrillator for primary prevention of patients with sudden cardiac death

作　　者：彭宇程[1] 黄启祥[1] 

机构地区：[1]江门市中心医院心内科,广东江门529030

出　　处：《岭南心血管病杂志》2017年第4期405-408,共4页South China Journal of Cardiovascular Diseases

摘　　要：目的分析心脏性猝死(sudden cardiac death,SCD)一级预防患者植入埋藏式心脏转复除颤器(implantablecardioverter defibrillator,ICD)的治疗效果及相关因素。方法选取江门市中心医院2007年5月至2016年4月SCD一级预防植入ICD患者100例进行程控随访,结合患者的临床资料进行回顾性分析。结果 100例患者随访(37.3±20.1)个月,有25例(25.0%)自发的室性心动过速(ventricular tachycardia,VT)/心室颤动(ventricular fibrillation,VF)事件,得到起搏器的正确诊断并进行适当ICD治疗[放电或抗心动过速起搏(anti-tachycardia pacing,ATP)],19例(19.0%)因起搏器错误诊断并进行了不适当ICD治疗(放电或ATP)。44例共诊断VF 271阵次(其中正确204阵次,占75.3%),VT 433阵次(其中正确217阵次,占50.1%),共放电治疗492次(其中正确270次,占54.9%),ATP治疗765次(其中正确342次,占44.7%,有效终止室心律失常158次,占46.2%)。动态心电图记录非持续性VT,ICD治疗组与非治疗组间非持续性VT≥5次/24 h比较,差异有统计学意义(P<0.05)。结论 SCD一级预防植入ICD患者得到获益;非持续性VT≥5次/24 h对SCD一级预防患者植入ICD有预测价值。Objectives To analyze the treatment effect and related factors of implantable cardioverter defibrillator （ICD） for primary prevention in patients with sudden cardiac death （SCD）. Methods A number of 100 patients implanted ICD for primary prevention of SCD were selected from May 2007 to April 2016. All the patients were followed-up regularly. The data combined with the clinical information of patients were analyzed retrospectively. Results The 100 patients were followed-up for（37.3±20.1）months. During follow-up,25 patients（25.0%）presented real ventricular tachycardia（VT）/ ventricular fibrillation（VF）events. They were diagnosed accurately by pacemaker and got appropriate ICD treatment[shock or anti-tachycardia pacing（ATP）]. Nineteen patients（19.0%）presented false VT/VF events and got inappropriate ICD treatment（shock or ATP）. A total of 44 patients experienced 271 times VF（204 times was right,75.3%）,433 times VT（217 times was right,50.1%）,492 times shock（270 times was right ,54.9%）,765 times ATP（342 times was right,44.7%;effectively stopping ventricular 158 times,46.2%）. Non-sustained VT （NSVT） was recorded by dynamic electrocardiography. There was statistically significant in NSVT≥5 times/24 h between ICD treatment group and non-ICD treatment group （P〈0.05）. Conclusions Patients with ICD for primary prevention of SCD can get benefit. There is a predictive value for NSVT≥5 times/24 h in SCD primary prevention patients implanted ICD.

关 键 词：心脏性猝死 一级预防 随访 植入心脏复律除颤器 心脏再同步治疗除颤器 

分 类 号：R541.7[医药卫生—心血管疾病]