第四代埋藏式心脏复律除颤器的临床应用

Clinical application of the fourth generation implantable cardioverter defibrillator

２例药物难治性室性心动过速（室速）患者应用了第四代埋藏式心脏复律除颤器（ＩＣＤ），根据电生理检查结果设置工作参数，采用阶梯治疗方案。术后随访发现２例均发生了术后心律失常“风暴”，抗心动过速起搏（ＡＴＰ）均有效终止了２例患者自发的室速。第一套ＡＴＰ程序成功率分别为９５％与９８％，其余被第二套ＡＴＰ程序所终止，总成功率１００％。２例术后都发生了对窦性心动过速误放电，在室速发现程序中加入突发性标准后得以纠正。１例因室速周长大于所程控的室速周长发现标准而导致室速时ＩＣＤ不放电，增加室速发现周长后未再发生类似情况。

Implantable cardioverter defibrillator (ICD)(Ventak PRXIII, CPI)were implanted in two patients with drug refractory ventricular tachycardias (VT). Tiered therapy were used in both patients and parameters were set according to the results of electrophysiological study. Following up revealed that postimplantation arrhythmic “storm” occurred in both patients and antitachycardia pacing (ATP) terminated all the episodes of spontaneous VT. The success rate of ATP 1 (programme 1) was 95% and 98% in two patients respectively and the rest episodes were terminated by ATP 2 (programme 2). The total success rate was 100%. Fault shocks occurred to sinus tachycardias in both of them and had not occurred again after adding the onset criterion for VT detection. ICD did not deliver therapy in an episode of VT in one patient because VT interval was greater than programmed VT detection interval and had not occurred again after increasing VT detection interval.