埋藏式心脏复律除颤器治疗恶性室性心律失常的随访观察

The Clinical Followup of Patients With Implantable CardioverterDefibrillators

对２２例埋置了埋藏式心脏复律除颤器（ＩＣＤ）的有晕厥史的恶性室性心律失常患者进行了随访，观察ＩＣＤ的治疗效果。２２例中扩张型心肌病８例、肥厚型心肌病２例、冠心病７例、ＱＴ延长综合症１例，４例未发现器质性心脏病。所有患者均经临床证实有室性心动过速或（和）心室颤动（ＶＴ／ＶＦ）发作。ＩＣＤ具有多项治疗及信息储存记忆功能（即第三代）。随访时通过体外程控仪调出ＩＣＤ储存的资料进行分析。平均随访７．１（１～２３）个月，１１例患者（５０．０％）ＶＴ／ＶＦ发作１１８次，其中５４次为非持续性ＶＴ，均自行终止；接受ＩＣＤ治疗的６４次为ＶＴ／ＶＦ发作，４５次为ＶＴ，２２次由ＩＣＤ的抗心动过速起搏（ＡＴＰ）终止、１６次由低能量（２～１５Ｊ）转复终止、２次发作为窦性心动过速（误判为ＶＴ），其余５次ＶＴ在ＡＴＰ治疗过程中加速转为ＶＦ，由高能量除颤终止。ＩＣＤ诊断的ＶＦ发作共有１９次，发生于４例患者，有１例患者接受除颤１６次，４次系为频率超过ＶＦ感知频率的ＶＴ。１９次发作均被ＩＣＤ有效除颤终止。２例扩张型心肌病患者，１例术后３个月死于心功能衰竭，另１例术后２个月反复发作ＶＦ，多次接受ＩＣＤ除颤治疗，最后死于心功能衰竭。结果表明常规进行?

Twentytwo patients,male 19 and female 3,mean age of 48.95 years were implanted nonthoracotomy implantable cardioverterdefibrillator (ICD) systems.The indication for implantation was ventricular fibrillation (VF) in 14 patients and refractory ventricular tachyarrhythmia (VT) in 8 patients.All patients had syncope out of hospital.The device is the third generation ICD with multitherapies including antitachycardia pacing (ATP),cardioversion,defibrillation and data storing function.In the followup of 7.1(1～23) months,11 out of 22 patients (50%) received ICD therapy.The data stored in ICD showed that there were total 118 episodes detected by the devices.54 of them were nonsustained VT which spontaneously terminated.64 VT/VF episodes were treated by ICD.45 of them were VT,22 were terminated by ATP and 16 by low energy cardioversion.2 episodes were sinus tachycardia.Another 5 VT were accelerated to VF and terminated by high energy shocks.There were 19 VF episodes diagnosed by the devices,however 4 of them were confirmed VT which rate over VF detection criterion by reviewed stored electrocardiogram.All the episodes were terminated by shocks.2 patients died of heart failure during the followup.Conclusion:The third generation of ICD with multitherapies function has high efficacy of termination of ventricular arrhythmias.It is important to followup the patients and set appropriate parameters of diagnosis and therapy of ICD.