植入型心律转复除颤器在长QT综合征患者中的应用

Role of implantable cardioverter defibrillator therapy in patients with long QT syndrome

目的总结阜外心血管病医院应用植入型心律转复除颤器（ICD）治疗长QT综合征（LQTS）患者的经验。方法8例LQTS患者接受了ICD治疗，平均年龄（38．9±16．7）岁。在随访期间，根据具体情况，调整ICD的各项程控参数。结果平均随访（27．3±25．9）个月，有3例患者出现了101次室性心动过速／心室颤动（VT／VF）事件。在出厂程控参数下，共记录到44次VF事件。重新设置VT／VF的识别及治疗参数后，共记录到57次VT事件，2次VF事件，大部分自行终止或经低能量转复成功。1例患者术后出现了电风暴，通过快速心室起搏，终止了尖端扭转性室性心动过速（Tdp）的反复发作。2例患者发生了因T波误感知导致的ICD误放电，通过延长感知灵敏度自动调整延迟，从而避免了T波误感知。结论针对LQTS患者的发病特点，调整ICD的程控参数，可以提高疗效并减少ICD误放电。

Objective To observe the role of implantable cardioverter defibrillator （ICD） therapy in patients with long QT syndrome. Methods ICD were planted in eight patients [4 men, 4 women, mean age （27.3 ± 25.9） years ] with long QT syndrome. In the follow-up, the parameters of ICD were adjusted according to ICD therapy. Result During the follow-up of （27.3 ± 25.9）months, ICD recorded 101 VT/VF episodes in 3 patients. With the traditional ICD progTamming,44 VF episodes were recorded. After the device parameters were adjusted according the YF episodes ,57 YT and 2 VF episodes were recorded, most of them self-terminated or terminated by low-energy shock. Electrical storm was presented in a patient, and we terminated it by increasing the base pacing rate. Inappropriate shocks due to T-wave oversensing were found in two patients, and it was avoided through adjusting the post-sensed Decay Delay. Conclusion Optimal device programming according to ICD therapy significantly decreases inappropriate ICD shocks and fewer unnecessary battery depletion and unnecessary shocks.