埋藏式自动复律除颤器的术后随访

The Follow up of Patients with Implantable Cardioverter Defibrillators

目的：总结８例患者安装新一代非开胸经静脉置入体内埋藏式自动复律除颤器（ＩＣＤ）的随访经验。 方法：８例患有药物难治性持续性室性心动过速（ＶＴ）的患者，安装了ＩＣＤ，术前均进行了心内电生理检查，据电生理检查结果设定ＩＣＤ的工作程序。在出院前及第１次心动过速发作后进行资料分析，术后每３～６个月随访１次。平均随访９．０±７．７个月（１～２３个月）。 结果：６例有心律失常发作并经ＩＣＤ治疗。在５５５ 次ＶＴ发作中，９４．６％ （５２５／５５５）由抗心动过速起搏终止，低能量电转复成功率５５．６％ 。高能量电转复成功率９１．７％ 。５例需更改治疗参数，１例术后３ 个月死于心源性休克。２例安装ＩＣＤ后，尚无心律失常发作，ＩＣＤ尚无工作。 结论：心内电生理检查对于指导ＩＣＤ工作程序设定具有重要意义。

Objective:The clinical follow up data of the patients with implantable cardioverter defibrillators(ICD) were presented. Methods:Eight patients with refractory sustained ventricular tachycardias(VT)underwent implantation of new generation ICD.The working program of ICD was set up according to the results of electrophysiologic study.Follow up evaluation of patients after ICD implantation was conducted before discharge,after the first spontaneous arrhythmia event and every 3～6 months after discharge. Results:During a mean follow up of 9 0±7 7 months,6 of the 8 patients had arrhythmia episodes.Antitachycardia pacing were effective for VT termination in 94 6% of 555 episodes.The success rates of low energy cardioversion and high energy cardioversion were 55 6% and 91 7%,respectively.It was necessary to adjustment the working parameters in 5 patients.One patient died of cardiogenic shock. Conclusion:Electrophysiologic studies are important in indication selection and the working parameter set up of the ICD.Careful postoperative observation and reprograming after spontaneous event are necessary.