植入型心律转复除颤器临床应用

Clinical application of implantable cardioverter-defibrillators

目的 观察 5例恶性室性心律失常患者植入型心律转复除颤器 (ICD)植入术及临床随访情况。方法 5例因反复发作有血流动力学障碍的室性心动过速 /心室颤动 (VT/ VF)均顺利植入 ICD(其中双腔 ICD2例 ) ,随访 6～ 2 4个月 ,观察患者临床疗效及 ICD工作情况。结果 5例患者无 1例死亡。随访期间共出现 VT/ VF事件 30 4次 ,ICD识别并治疗的 VT/ VF事件 71次 ,VT 6 5次 ,占 91.5 % ,VF 6次 ,占 8.5 % ,抗心动过速起搏 (ATP)终止 5 5次 ,占77.5 % ,心律转复 (CV)终止 16次 ,占 2 2 .5 % ,VF经除颤 (DF)全部一次成功。结论 ICD的治疗效果肯定 ,需加强随访 ,及时修改参数 ,同时应加强药物的辅助治疗 ,如 β-受体阻断剂 ,胺碘酮等 ,积极改善心功能。

Objective To observe clinical and follow-up data in 5 consecutive patients with implantable cardioverter-defibrillators(ICD).Methods From August 2001 to August 2003, 5 patients with recurrent ventricular tachycardia and fibrillation(VT/VF) received ICD. The duration of follow up was 6~24 months.Results None of 5 patients died,there were total 304 episodes(VT/VF) detected by the devices, 71 episodes were treatment by ICD,65(91.5%) of them were VT,6(8.5%) of them were VF, 55(77.5%)were terminated by ATP, and 16( 22.5%) by low energy cardiovertion.total VF events were once recovered to sinus rhythm successfully.Conclusion The third generation of ICD with tiered therapy function has high efficacy of termination of ventricular tachyarrhythmias. It is important to follow up the patients, and set appopriate parameters of diagnosis and therapy of ICD.