心律转复除颤器植入术中避免常规除颤阈值测试的随访观察

Efficacy and safety of implantable cardioverter defibrillator avoiding routine defibrillation threshold testing

目的:探讨心律转复除颤器(ICD)和心室再同步心脏转复除颤器(CRT-D)植入术中未进行除颤阈值测试的患者,治疗恶性室性心律失常的有效性和安全性。方法:收集1999年10月至2008年8月间ICD植入术中未进行除颤阈值测试的21例ICD/CRT-D患者临床资料,应用体外程控仪获取存取信息并结合随访资料进行分析。结果:17例室性心动过速(室速)或心室颤动(室颤)患者植入ICD,4例心肌病合并严重心力衰竭患者植入CRT-D,术中均未进行除颤阈值测试。8例术后1周进行除颤阈值测试,其中3例(37.5%)未诱发出室速/室颤。程控随访1～7(4.2±1.9)年,21例未进行除颤阈值测试的患者中16例记录到室速或室颤事件,ICD成功除颤89阵(成功率100%),抗心动过速起搏(ATP)终止室速120阵次(成功率51.1%),低能量同步转复22阵次(成功率59.2%)。术后大多数患者联合应用抗心律失常药物,无恶性室性心律失常相关死亡病例。结论:ICD/CRT-D植入术中不常规进行除颤阈值测试可避免相关并发症发生,术后随访可有效治疗恶性室性心律失常,预防心脏性猝死。

Objective To evaluate the efficacy and safety of implantable cardioverter defibrillator （ICD） and cardiac resynehronization therapy-defibrillators （CRT-D） avoiding defibrillation threshold （DFT） testing when treating ventricular tachycardia （VT） or ventricular fibrillation （VF）. Methods We analyzed a continuous database of the 21 patients who had avoided DFT during ICD implantation from Oct. 1999 to Aug. 2008. Follow-up data were completed and analyzed in the 21 patients with ICD implantation. Results ICDs were implanted successfully in 17 patients with VT or VF, and CRTD were implanted successfully in 4 myoeardiopathy patients with severe heart failure who avoided DFT during ICD or CRT-D implantation. Eight patients accepted DFT 1 week later, VT or VF was not induced in 3 patients （37.5%）. During the mean follow-up of 1 -7 （4.2 ± 1.9） years, malignant ventricular arrythmia was recorded in 16 patients. Among them, 89 episodes were successfully terminated by defbrillation （ 100 % ） , 120 VT events were terminated by the first run of antitachycardia pacing （51. 1% ） and 22 by low engery cardioversion （59.2%）. All paitents took antiarrhycardia drugs af- ter ICD or CRT-D implantation. No patient died from malignant ventricular arrythmia during the followup. Conclusion No application of routine DFT may aviod complications associated with DFT during ICD or CRT-D implantation. ICD or CRT-D implantation may effectively treat fatal ventricular tachyarrhythmias and prevent sudden cardiac death.