心房颤动体外电复律治疗对心脏植入电子装置远期影响的观察  

The long-term impact of external cardioversion for atrial fibrillation in patiens with cardiac implantable electronic device

作　　者：刘俊鹏[1] 杨杰孚[1] 佟佳宾[1] 邹彤[1] 施海峰[1] 陈浩[1] 都明辉 吴素娟[1] 王志蕾[1] 金鑫[1] LIU Jun-peng;YANG Jie-fu;TONG Jia-bin;ZOU Tong;SHI Hai-feng;CHEN Hao;DU Ming-hui;WU Sujuan;WANG Zhi-lei;JIN Xin(Department of Car diology,Beijing Hospital,National Cent er of Gerontology,Beijing 100730,China)

机构地区：[1]北京医院心内科国家老年医学中心,北京100730

出　　处：《中国心脏起搏与心电生理杂志》2020年第2期116-119,共4页Chinese Journal of Cardiac Pacing and Electrophysiology

摘　　要：目的评估心房颤动(简称房颤)体外电复律治疗对心脏植入型电子装置(CIED)的远期影响。方法前瞻性入选中心2016年1月至2017年12月植入CIED伴房颤并接受体外电复律患者(电复律组)和植入CIED非房颤患者(对照组),电复律组接受体外电转律(前后位电复律方式,距离CIED装置≥8 cm,双相波直流电同步电复律200 J),在电复律前、电复律后1、6及12个月测试CIED装置及电极参数。对照组,在入选即刻,入选后1、6及12个月测试CIED电极参数。结果入选并完成随访共43例CIED患者,其中电复律组21例,对照组22例。按照规范的电复律操作,选择200 J高能量放电,单次房颤转律成功率达100%,未造成CIED系统故障和失灵,通过一年观察,与基线比较,电复律组CIED电池性能及电极各参数稳定。与对照组比较,电复律组的心房电极阻抗在1、6及12月时变化幅度较对照组均存在显著差异,心室电极阻抗仅6个月时存在显著差异,起搏阈值和感知参数无差异,未发生任何参数变化而导致的临床不良事件。结论接受房颤电复律治疗的CIED患者,按照规范的体外电复律操作,初始200J高能量,复律成功率高,不造成CIED影响。Objective To evaluate the long-term impact of external cardioversion(ECV)for arial fibrillation(AF)in patiens with cardiac implantable electronic device(CIED).Methods From January 2016 to December 2017,we enrolled patients with CIED who received ECV for AF(ECV group)and those with CIED and non-atrial fibrillation(control group).Patiens in ECV group received 200 J biphasic shock with anteroposterior paddle orientation.Systems were tested before ECV,1 month,6 month and 1 year later with repect to device and lead integrity.In control group,systems were tested immediately,1 month,6 month and 1 year later.Results Fourty-three patients were enrolled,including 21 in ECV group and 22 in control group.Follow the standard operation of ECV,the success rate of cardioversion is 100%.There were no instances of physical dysfunction of the device,spurious programming or electrical reset induced by the shock.After one year observation,CIED battery and lead parameters were stable compared with baseline.Compared with the control group,the change of atrial pacing impedance was significantly changed in 1 month,6 month and 1 year,and the change of ventricular pacing impedance was significantly changed in 6 month,without any adverse clinical events caused by any parameter change.Conclusion Follow the standard operation of ECV with a biphasic energy lever of 200 J,ECV for AF seems to be safe and effective in patients with CIED.[Chinese Journal of Cardiac Pacing and Electrophysiology,2020,34(2):116-119]

关 键 词：心血管学 心脏植入型电子器械 体外电复律 心房颤动 

分 类 号：R541.75[医药卫生—心血管疾病]