植入型心律转复除颤器在20例Brugada综合征患者中的临床疗效分析  

Efficacy and safety of implantable cardioverter defibrillator in patients with Brugada syndrome

作　　者：闫丽荣[1] 戴研[1] 陈柯萍[1] 李玉秋[1] 李超[1] 吴瑛[1] 陈若菡[1] 孙奇[1] 华伟[1] 张澍[1] Van Lirong;Dai Yan;Chen Keping;Li Yuqiu;Li Chao;Wu Ying;Chen Ruohan;Sun Qi;Hua Wei;Zhang Shu(Center of Arrhythmia,Fuwai Hospital,Chinese Academy of Medical Sciences,Peking Union Medical College,Beijing 100037,China)

机构地区：[1]中国医学科学院北京协和医学院国家心血管病中心心血管疾病国家重点实验室阜外医院心律失常中心,100037

出　　处：《中华心律失常学杂志》2019年第1期18-23,共6页Chinese Journal of Cardiac Arrhythmias

基　　金：国家科技支撑计划(2006BAI01A05).

摘　　要：目的本研究旨在总结分析国内Brugada综合征患者接受植入型心律转复除颤器(ICD)治疗的有效性和安全性。方法连续入选2009年1月至2017年12月在阜外医院植入ICD的Brugada综合征患者,收集并回顾性分析患者基线特征、ICD恰当治疗、不恰当治疗及ICD植入相关并发症等数据。结果本研究共纳入20例接受ICD治疗的Brugada综合征患者,平均年龄(47.6±8.6)岁,男18例(90.0%),女2例(10.0%)。7例(35.0%)患者有心脏性猝死家族史;既往晕厥患者9例,心脏骤停患者5例,多形性室性心动过速(室速)患者1例,无症状患者5例。平均随访(51.4±40.4)个月,7例(35.0%)患者接受1次及以上的ICD恰当治疗,其中1例患者发生电风暴,ICD恰当治疗率为9.9%/年;有症状(晕厥、心脏骤停或多形性室速)患者ICD恰当治疗率高于无症状患者,但差异无统计学意义(40.0%对20.0%,P=0.613)。随访期间7例(35.0%)患者发生ICD不恰当治疗,ICD不恰当治疗率为7.7%/年。2例(10.0%)患者发生ICD植入相关并发症,随访期间无死亡事件发生。结论Brugada综合征患者ICD恰当治疗率较高,尤其基线水平有症状患者,然而无症状患者中亦发生了ICD恰当治疗,尚需进一步研究完善危险分层从而指导临床治疗;不恰当治疗率亦较高,但多数可通过调整ICD参数得到解决。Objective To analyse the efficacy and safety of implantable cardioverter defibrillator(ICD)in patients with Brugada syndrome.Methods We retrospectively studied Brugada syndrome patients who had ICD implanted in Fuwai Hospital from January 2009 to December 2017.Outcome data,including appropriate ICD therapy,inappropriate therapy and the complications associated with ICD implantation were obtained.Results Twenty consecutive patients were included in this study.The proportion of males(n=18,90.0%)is higher than females(n=2,10.0%),and the average ICD implanted age was(47.6±8.6)years.Seven patients(35.0%)had family history of sudden cardiac death(SCD).Nine patients(45.0%)presented with unexplained syncope,5 patients presented with aborted cardiac arrest,and 1 patient presented with polymorphic ventricular tachycardia(PMVT).Five patients(25.0%)were asymptomatic before device implantation.Over a mean follow-up period of(51.4±40.4)months,ICD provided appropriate therapy to 7 patients(35.0%),the appropriate ICD therapy rate was 9.9%/year.Although there was no significant difference,the rates of appropriate therapy for symptomatic patients was higher than for asymptomatic patients(40.0%vs.20.0%,P=0.613).Inappropriate therapy occurred in 7 patients(35.0%),and the inappropriate ICD therapy rate was 7.7%/year.Two patients(10.0%)experienced complications associated with ICD implantation.There was no death case during the follow-up.Conclusion The rate of appropriate ICD therapy in Brugada syndrome is high,especially in symptomatic patients,but also occurred in asymptomatic patients.The frequency of inappropriate ICD therapy is high.However,most of which could be reduced by careful device programming.

关 键 词：除颤器 植入型 BRUGADA综合征 心脏性猝死 

分 类 号：R541.7[医药卫生—心血管疾病]