心脏再同步化治疗除颤器在慢性心力衰竭患者中的临床应用

Efficacy of cardiac resynchronization therapy-defibrillator for treating patients with chronic heart disease

目的总结具有心脏再同步化治疗(CRT)和埋藏式自动复律除颤器(ICD)功能的心脏再同步化治疗除颤器(CRT-D)用于临床治疗慢性心力衰竭(心衰)的初步经验。方法 17例药物治疗无效的慢性心衰患者接受了 CRT-D 治疗,其中6例患者接受了具有心衰预警功能的 InSync Sentry。基础病因为扩张性心肌病12例,缺血性心肌病5例;13例患者既往有室性心动过速或心室颤动的发作病史。结果 17例患者均成功置入 CRT-D,左室导线平均起搏阈值为1.6 V,除颤阈值≤20 J,无并发症发生。平均随访13个月,5例患者发生室性心动过速诱发的电击除颤。1例置入 InSync Sentry的患者由于心功能恶化出现2次心衰报警事件,药物治疗后好转。结论 CRT-D 置入手术相对安全,不仅能改善患者心功能,而且可预防心脏性猝死的发生。

Objective To observed the chnical efficacy of cardiac resynchronization therapydefibrillator （CRT-D） in selected patients with chronic heart failure one year after implantation. Methods Seventeen patients with drug-refractory heart failure received CRT-D implantation （6 patients were implanted with InSync Sentry）. The underlying heart diseases were dilated cardiomyopathy in 12 patients and ischemic heart disease in 5 patients. There were 13 patients with a history of ventricular tachycardia/ventricular fibrillation. Results CRT-D were successfully implanted in all patients without complication. The mean left ventricular pacing threshold was 1.6 V. The defibrillation threshold was no more than 20 J. During a mean follow-up of 13 months, no death occurred and LV function was improved. The shock induced by ventricular tachycardia was delivered in 5 patients and alarming due to heart failure occurred twice in 1 patient. Conclusions The implantation of CRT-D for treating refractory heart failure patients is feasible and safe. The application of CRT-D was associated with an improved cardiac function and a reduced risk of sudden cardiac death.