胸前植入埋藏式心律转复除颤器——一种简易的植入方法

以往的开胸植入ICD系统手术操作繁琐,并发症多,非开胸植入ICD系统的应用降低了手术相关的并发症.本文介绍了新一代的经静脉胸前植入ICD.25例恶性室性心律失常患者应用了第三代非开胸植入ICD系统,其中18例为单极除颤系统.25例患者中24例(96%)除颤阀值≤24焦耳,而成功地植入了ICD.另一例由于阈值偏高而改用了开胸植人.所有患者的ICD均埋藏于患者的左胸前的皮下组织或胸大肌下的束袋中,除一例患者术后发生束袋血肿外,无明显并发症.经静脉胸前植入ICD手术切口少,操作简单,并发症较少,临床应用效果满意,将逐渐取代开胸植入系统.

Implantable Cardioverter Defibrillators (ICD) implantation initially required a thoracotomy for epicardial patch placement, and the procedure was associated with a risk of mortality and morbidity. This study presents a new approach - nonthoracotomy subpectoral implantation of ICD. The new generation of nonthoracotomy ICD system were implanted in 25 patients with malignant ventricular tachyarrhythmias. All ICD were implanted in subpectoral area of the patients with one incision. Satisfactory defibrillation threshold were obtained by transveneous defibrillation system in 24 out of 25 patients (96% ) .No significant complication was observed except one patient developed ICD pocket hamotoma required management . Subpectoral implantation of the ICd is feasible and was well tolerated by all patients. As the size of future generation ICD is reduced,subpectoral implantation may become the preferred approach.