植入型心律转复除颤器在心力衰竭心脏性猝死一级预防中的作用初步观察

Implantable cardioverter defibrillator therapy for primary prevention of sudden cardiac death in patients with heart failure

目的总结我院应用植入型心律转复除颤器（ICD）进行心力衰竭心脏性猝死（SCD）一级预防的初步经验。方法入选我院近3年因严重心力衰竭植入ICD进行SCD一级预防的患者，术后3个月进行ICD常规随访，以后每6个月随访1次。结果入选患者22例，其中单腔ICD15台，双腔ICD7台。22例患者随访时间3～28个月。记录ICD治疗事件21次，包括12次抗心动过速起搏（ATP）治疗和9次放电，只有1次ATP治疗患者具自觉症状。其中正确治疗（appropriate therapy）11次（52％）包括8次ATP治疗和3次放电，误治疗（inappropriate therapy）10次（48％）。发生误治疗患者均为植入单腔ICD。结论ICD可以安全有效地应用于心力衰竭SCD的一级预防，ICD误治疗事件是值得重视的临床问题，合理的ATP治疗可以提高患者的生活质量。

Objective To evaluate the effectiveness of implantable cardioverter defibrillator （ICD） therapy for primary prevention of sudden cardiac death （SCD） in patients with heart failure. Methods Twenty-two consecutive heart failure patients implanted with ICD for primary prevention of SCD in last 3 years were enrolled and followed up 3 months after implantation and every 6 months afterwards. Results Totally 22 cases were enrolled, including 15 with single-chamber ICD and 7 with dual-chamber ICD. Twenty-one ICD therapy events were documented during 3 - 28 months follow-up period, including 12 anti-tachycardia pacing （ATP） therapies and 9 shocks, and only one had symptoms. Eleven therapies （52% , 8 ATP therapies and 3 shocks） were classified as appropriate, and 10 （48%） as inappropriate. All inappropriate therapies were occurred in patients implanted with single-chamber ICD. Conclusion In heart failure patients ICD for primary prevention of SCD was effective and appropriate. Relatively high incidence of inappropriate therapies remains a challenge. ATP therapy may improve the quality of life in ICD patients.