埋藏式心脏转复除颤器不恰当放电治疗原因分析及处理  

Causes and management of inappropriate shocks in patients with implantable cardioverter defibrillator

作　　者：王三娣[1] 杨新玮 韩宏伟[1] 李振[1] 叶菊芬[1] 董倩倩 李佳 WANG San-di;YANG Xin-wei;HAN Hong-wei;LI Zhen;YIE Ju-fen;DONG Qian-qian;LI Jia(Department of Cardiology,Asia Heart Hospitals Wuhan 430022,Hubei,China)

机构地区：[1]武汉亚洲心脏病医院心内科,湖北武汉430022

出　　处：《中国心脏起搏与心电生理杂志》2021年第5期420-425,共6页Chinese Journal of Cardiac Pacing and Electrophysiology

摘　　要：目的探讨埋藏式心脏转复除颤器(ICD)不恰当电击的原因及处理,尽可能减少ICD不恰当电击。方法回顾分析2015年7月至2020年7月武汉亚洲心脏病医院ICD程控检查中11例不恰当电击患者的原因及处理。结果 11例患者不恰当电击治疗共62次,最多的1例患者21次,最少的1次。T波感知2例,心房颤动4例,窦性心动过速3例,右室导联完整性受损1例,外部电磁干被电击1例。发生不恰当电击后通过ICD腔内图、治疗效果、病人当时的症状,病史等认真分析,合理设置的ICD参数和/或相应处理,减少了ICD不恰当电击。结论 ICD植入术后随访程控能发现不恰当的放电原因,调整参数或相应处理能避免不恰当放电。Objective To investigate the causes and treatment of inappropriate shock in patients with implantable cardioverter defibrillator(ICD), and to reduce inappropriate shock in patients with ICD as much as possible. Methods The causes and treatment of 11 patients with inappropriate electric shock in ICD program-controlled examination in Wuhan Asian Heart Hospital from July 2015 to July 2020 were retrospectively analyzed. Results Eleven patients were treated with inappropriate electric shock for 62 times, the most one patient was 21 times, the least one time. The causes for improper shocks included oversensing of T wave in 2 patients, atrial fibrillation in 4 patients, sinus tachycardia in 3 patients. The integrity of right ventricular lead was damaged in 1 case, and the external electromagnetic trunk was shocked in 1 case. After the occurrence of inappropriate shock, through careful analysis of ICD intracavity map, treatment effect, patient’s symptoms at that time, medical history and so on, reasonable ICD parameters and/or corresponding treatment were set to reduce the inappropriate shock of ICD. Conclusions After ICD implantation, inappropriate discharge causes can be found by calling out the data of follow-up program, and inappropriate electric shock can be avoided by adjusting the parameters or corresponding treatment. [Chinese Journal of Cardiac Pacing and Electrophysiology,2021,35(5):420-425]

关 键 词：心血管病学 埋藏式心脏复律除颤器 不恰当电击 鉴别诊断 

分 类 号：R318.ll[医药卫生—生物医学工程]