12例慢性心力衰竭患者植入心律转复除颤器作为心脏性猝死的一级预防

Implantable cardioverter defibrillator used as the primary prevention for sudden cardiac death in 12 patients with chronic heart failure

目的探讨植入型心律转复除颤器(ICD)对慢性心力衰竭患者心脏性猝死的一级预防作用。方法12例缺血性或非缺血性心肌病患者,男性11例,女性1例,平均年龄59．4岁。心功能Ⅱ～Ⅲ级(NYHA分级),左心室射血分数0．23～0．36,常规进行标准抗心力衰竭治疗。患者均行ICD植入,并进行ICD参数的设置。术后1、3、6个月,以后每6个月随访1次,观察病人的临床症状,随访时通过体外程控仪调出ICD储存的资料进行分析,了解恶性心律失常的发生情况,ICD的工作情况。结果术中及随访期间无死亡及心力衰竭加重,无手术并发症。全部病例随访了3～30个月,其中2例患者发生心室颤动(室颤),除颤成功,3例患者发生室性心动过速,ATP转复成功,1例患者因心房颤动快速心室率发生误放电,通过药物控制心室率及调整ICD参数,未再发生误放电。结论12例心力衰竭患者中在随访期内(3～30个月)5例(42％)发生了室颤或室性心动过速,均经ICD成功复律。因此,ICD能有效预防慢性心力衰竭患者的心脏性猝死。

Objective To evaluate the effect of implantable cardioverter defibrillator （ICD） on the primary prevention for sudden cardiac death （SCD） in patients with either ischemic or nonischemic dilated cardiomyopathy with chronic heart failure. Methods There were 12 patients, 11 males and 1 female, mean age of 59.4 years old. They were diagnosed as either ischemic or nonischemic dilated cardiomyopathy with NYHA class of cardiac function Ⅱ to ⅢCHF and left ventricular ejection fraction （LVEF） 0.23 - 0.36. All patients accepted the standard drugs therapy of heart failure. ICD was implanted in each patient and each was followed up in 1 month, 3 months, 6 months, thereafter every 6 months. After that, each patient was reviewed in 6 months to assess the clinical symptoms and analyse the storing data of ICD with programmer to evaluate the occurrence of ventricular arrhythmias and the status of ICD. Results There was no death, aggravation of cardiac function and complication during and/or after the implantation. During follow-up of 3 30 months, 2 patients had VF, which were defibrillated successfully, and 3 patients had VT,which were terminated successfully by the device with ATP. ICD discharged inappropriately in 1 patient who had atrial fibrillation （AF） with rapid ventricular response. By prescribing drugs and resetting parameters, incorrect discharge had been avoided. Conclusion Implanting ICD is an effective way to prevent sudden cardiac death in patients with chronic heart failure.