安置埋藏式心脏复律除颤器术后电风暴的治疗体会

Treatment of electrical storms in patients after implantation of implantable cardioverter defibrillator

目的:总结埋藏式心脏转复除颤器(ICD)电风暴(ES)的诱发因素、临床处理和预后。方法:ES定义为24h内簇发3次或3次以上需经ICD干预的VT/VF事件。回顾分析2003年1月至2008年1月南方医院7例ICD患者发生的8次ES临床资料。结果:7名患者植入ICD后发生ES8次。诱发因素为低钾血症3次、心力衰竭2次、上呼吸道感染、心肌缺血和紧张恐惧各1次等。均祛除诱因,加强药物治疗,其中1例加行室性心动过速的射频消融,另1例加行经皮冠状动脉介入治疗。8次ICD风暴均全部终止。结论:通过纠正诱因,使用抗心律失常药物,调整ICD设置,必要时行射频消融术或冠脉血运重建,能有效地终止ES。

Objective To evaluate the inducers, clinical treatment, and prognosis of electrical storm （ES） in patients after implantation of implantable cardioverter defibrillators （ICD）. Methods ES is defined as three or more VT / VF events that occurred during 24 hours which needed to be intervened by ICD. Data of 8 times of ES from 7 patients after implantation of ICD from Nanfang hospital from Jan 2003 to Jan 2008 were collected and analyzed retrospectively. Results Among the 8 times of ES, 3 were induced by hypokalemia, 2 were induced by heart failure, and the other 3 were induced by myocardial isehemia, severe infection of upper respiratory tract, and sympathetic hyperactivity, respectively. All of the patients received elimination of inducers and medical treatments. One of them was implemented with radiofrequency catheter ablation due to hemodynamieally stable ventricular tachycardia, and one was treated with percutaneous coronary intervention （PCI）. All of the 8 E5 were successfully terminated. Conclusion ES can be successfully terminated by eliminating the incentives, using the auti-arrhythmic medications, adjusting the ICD setting, and implementing radiofrequency catheter ablation or PCI if necessary.