皮下植入式心律转复除颤器在缺血性心肌病一级预防筛查中的研究  

The study with primary prevention screening of subcutaneous implantable cardioverter defibrillator within ischemic cardiomyopathy

作　　者：向虹[1] 鲁仲巧 王礼琳[1] 范洁[1] XIANG Hong;LU Zhongqiao;WANG Lilin;FAN Jie(Department of Cardiology,Affiliated Hospital of Kunming University of Science and Technology,the First People’s Hospital of Yunnan Province,Kunming,650034,China;Department of Cardiology,Wenshan People’s Hospital)

机构地区：[1]云南省第一人民医院,昆明理工大学附属医院心血管内科,昆明650034 [2]文山州人民医院心内科

出　　处：《临床心血管病杂志》2021年第2期141-145,共5页Journal of Clinical Cardiology

摘　　要：目的:本文旨在研究具有埋藏式心脏转复除颤器(ICD)一级预防指征的缺血性心肌病患者中,皮下植入式心律转复除颤器(S-ICD)植入术前模拟体表心电图筛查在自动筛选工具(AST)和手动筛选工具(MST)两种筛查方式中的通过率及其影响因素,探讨常规12导联心电图与S-ICD的3个感知向量之间的关系,及其能否独立完成S-ICD植入前的筛查。方法:入组于云南省第一人民医院心血管内科就诊的符合S-ICD植入一级预防的缺血性心肌病患者69例,利用3120程控仪对每例患者进行模仿S-ICD装置感知向量的描记,采集12导联心电图,分别利用AST和MST对3个模拟感知向量进行分析,并得出筛选结果。结果:69例受检者中,通过AST筛查66例(95.7%),通过MST筛查63例(91.3%)。在AST与MST两种筛查方式中,Ⅱ导联通过率最高,AST筛查明显提高主要向量筛查通过率(MST 60%∶AST 80%,P<0.001)和次要向量筛查通过率(MST 64%∶AST 86%,P=0.002),也提高了备选向量筛查通过率(MST 63%∶AST 72%,P<0.001)。MST和AST体表心电图筛查结果之间的一致性无显著差异,但AST和MST两种筛查工具在单个感知向量水平上一致性的比较存在显著差异。在MST筛查中,63例(91.3%)体表ECG形态分析通过筛查。静息状态下常规12导联ECG筛查通过组和未通过组Ⅰ导联的T波、Ⅱ导联及avF导联的R波、Ⅰ导联及Ⅱ导联的R/T存在明显差异(P<0.05)。结论:与MST相比,AST在单一导联上筛查通过率明显提高,MST与AST对识别不合格患者都有很高的敏感性,而对于识别真正适合植入S-ICD患者二者均缺乏特异性。临床常规12导联ECG部分导联可用于预判S-ICD体表心电图的通过情况,但不能单独进行S-ICD术前筛查。Objective: To investigate the pass rate and screening failure factors of pre-implantation simulated surface electrocardiogram(ECG) screening by the two ways of AST and MST for patients with implantable cardioverter defibrillator(ICD) in primary prevention. Methods: The 69 patients with primary prevention of S-ICD were recorded the specialized 3-lead ECG electrodes according to using the Model 3120 Zoom Latitude Programmer. Special 3-lead ECGs were analyzed and assessed by using the MST and AST. Results: In 69 patients, 66 patients(95.7%) of AST screening tool and 63 patients(91.3%) of MST screening tool were passed successfully. In AST and MST screening tool, the pass rates of Ⅱ qualifying leads were highest, and in AST screening tool, the pass rates of primary vector(MST 60% vs. AST 80%, P<0.001), secondary vector(MST 64% vs. AST 86%, P=0.002) and alternate vector(MST 63% vs. AST 72 %, P<0.001) were higher than MST screening tool. The consistency of Body surface 12-lead ECG between AST and MST was not exist obvious difference. The consistency of either of specialized 3-lead ECG electrodes was exist obvious difference. In MST, the pass rate of surface 12-lead ECG was 91.3%. Conclusion: Compared with MST, AST has significantly improved the pass rate of screening on a single lead. AST show a high agreement with MST for S-ICD, but both of whom lack the specificity to identify truly qualified patients for S-ICD implantation. Clinical routine 12-lead ECG can be used to predict the qualification of S-ICD, but it is not possible for the eligibility of S-ICD to complete screening independently.

关 键 词：全皮下植入式心律转复除颤器 缺血性心肌病 一级预防 筛查 

分 类 号：R541.7[医药卫生—心血管疾病]