埋藏式心脏转复除颤器的长期随访观察

Clinical follow up of implantable cardioverter defibrillator in four patients

目的分析埋藏式心脏转复除颤器(ICD)治疗恶性室性心律失常的疗效。方法4例患者中共置入6台ICD,通过常规心电图、动态心电图及ICD程控分析仪进行随访,对患者情况及ICD工作情况进行分析,合理调整起搏参数,心律失常药物,及时处理ICD故障。结果6台ICD共检出心律失常事件272次,启动治疗程序64次,其中包括低能量复律和高能量除颤转复室性心动过速和心室颤动19次(占29.7%,19/64),抗心动过速起搏成功治疗室性心动过速35次(占54.7%,35/64),误放电治疗10次(占15.6%,10/64)。误放电原因包括:感知窦性心动过速3次,电磁干扰2次,电极导线绝缘层破损干扰5次。其余208次心律失常事件均在ICD启动诊断识别过程中自行终止,ICD未继续实施治疗程序。结论ICD治疗恶性室性心律失常效果肯定,但应加强随访,警惕误放电。

Objective To analyze the efficacy of implantable cardioverter defibrillator（ICD） in treating malignant ventricular arrhythmia. Methods 6 ICD were implanted in 4 patients. The stored data was collected and analyzed from ICD memory by special programmer. The follow up time was from 1 to 10 years. Results 272 times arrhythmia episodes were detected in 6 ICD. Treatment program were switched on 64 times,including low energy cardioverter and high energy cardiac defibrillation to terminate ventricular fibrillation for 19 times（ account for 29.7%, 19/64）, antitachycardia pacing to treatment ventricular tachycardia for 35 times （account for 54.7% ,35/64）, 10 times （account for 15.6%, 10/64） inappropriate shock delivery occurred. The causes of inappropriate discharges included oversensing sinus tachycardia （3 times）, electromagnetic interference （2 times）, lead insulation breaks （5 times） ,which accounted for 30% ,20% and 50% total inappropriate discharges, respectively. The other 208 times tachycardia automatically terminated during ICD diagnosis and recognization procedure. The ICD did not start treatment program. Conclusions ICD has a good effect on treatment of malignant ventricular arrhythmia. We should enhance follow up and vigilance inappropriate shock delivery.