全皮下埋藏式心脏转复除颤器筛选通过率及其影响因素的初步分析  

How many patients satisfy the ECG screening template of subcutaneous implantable cardioverter defibrillator and its possible influence factors

作　　者：郭兰燕[1] 张敏霞 胡淼阳 沈敏[1] 武峰[1] 苑媛[1] 刘兵[1] 

机构地区：[1]第四军医大学西京医院心血管内科,陕西西安710032

出　　处：《中国心脏起搏与心电生理杂志》2017年第5期408-412,共5页Chinese Journal of Cardiac Pacing and Electrophysiology

摘　　要：目的初步探讨符合埋藏式心脏转复除颤器一级和/或二级预防的患者全皮下ICD(S-ICD)筛选通过率及其影响因素。方法收集符合ICD植入的一级和/或二级预防,无心动过缓起搏依赖病人51例的临床资料,采集卧位和坐位体表心电图(TMS-ECG)来模拟S-ICD的感知向量,两个体位至少一个向量同时满足S-ICD筛选模板方认为筛选通过。结果 51例患者中有45.1%的患者经静脉植入ICD,一共有36例(70.6%)病人通过筛查,筛选通过组Ⅰ(可选向量)、Ⅲ导联(主要向量)通过率均为66.7%,Ⅱ导联(次要向量)通过率最高,为86.1%;3个导联均通过者约38.9%,2个导联通过者约47.2%,1个导联通过者最少,约13.9%。S-ICD筛选失败组(n=15)在12导联体表心电图QRS宽度、完全性左束支传导阻滞比例、Rmax、R/Tmax与筛选通过组之间有明显差异(P均<0.05)。结论符合ICD植入指征的患者实际植入ICD的比例较低,约45.1%。70.6%的病人通过S-ICD筛查模板,其中Ⅱ导联通过率最高,两个导联同时通过者比例高于1个和3个导联通过者。基线体表心电图QRS增宽、合并完全性左束支传导阻滞、Rmax较低以及R/Tmax比值较小者筛选失败的可能性更大。Objective To initially investigate how many patients, who had high risks of sudden cardiac death, sat- isfied the QRS-T ECG template and its possible influence factors. Methods To collect 51 patients clinical data who were suitable for primary and/or secondary prevention for implantable cardioverter defibrillator （ICD）implan- tation, but no pacing needs as a result of bradycardia. We get TMS-ECG to simulate the sensing vectors of subcuta- neous ICD （S-ICD）, and S-ICD eligibility required at least one leads/vector to satisfy the screening template in both supine and standing positions. Results Only less than half of patients （45.1%） who were necessary for ICD to prevent SCD underwent transvenous ICD implantation. 36 patients （70.6%） passed successfully the S-ICD screening template. And among the three vectors, the S-ICD screening template was satisfied more often by lead II （seconda- ry vector, 86.1% ） compared with lead I （alternate vector） and lead m （primary vector） （all 66.7 % ）. The proportion of patients with 3,2 and 1 qualifying leads were 38.9%, 47.2% and 13.9% respectively. There was a statistical difference at QRS duration, left bundle block （LBBB）,Rmax and R/Tmax in conventional 12-leads ECG between the eligible and not eligible groups （all P 〈0.05）. Conclusion There is a really low rate （45.1%） of ICD implan- tation for those who are at high risk of SCD. About 70.6% of patients, with an indication of ICD for primary and/or secondary prevention of SCD, have a satisfied surface ECG that is proper for S-ICD implantation when assessed with S-ICD ECG screening template, and lead II is the most easily passed among the three leads. In the mean time, two leads are more qualified for screening template than one or three leads. When patients with a longer QRS duration, LBBB, less Rmax and R/Tmax are more easily be unsuitable for S-ICD, so we should pay more attention to such people before screening and implantation of S-ICD.

关 键 词：心血管病学 心脏性猝死 皮下心脏除颤器 筛选模板 

分 类 号：R541.78[医药卫生—心血管疾病] R318.11[医药卫生—内科学]