ICD在恶性室性心律失常治疗中的应用

The clinic evaluation of implanted cardioverter defibrillators in malignant ventricular arrhythmia

目的观察埋藏式心脏复律除颤器（ICD）在治疗恶性室性心律失常中的作用。方法对2005年1月至2009年11月在我院植入ICD的96例患者的临床资料及植入ICD后的长期随访结果进行回顾性分析,其中男80例,女16例,年龄14~79岁（53±12.2岁）。结果①植入ICD进行一级预防的患者32例（33.33%）,二级预防64例（66.67%）;②病因分析显示致心律失常性右室心肌病11例（11.46%）,肥厚型心肌病8例（8.33%）,缺血性心肌病29例（30.21%）,扩张型心肌病13例（13.54%）,长QT综合征1例（1.04%）,Brugada综合征10例（10.42%）,多形性室速19例（19.79%）,特发性室颤4例（4.17%）,心肌致密化不全1例（1.04%）;③临床表现为持续性室速或室颤64例（66.67%）,其中合并有房速16例（16.67%）;④起搏模式为：单腔ICD54例（56.25%）,双腔ICD42例（43.75%）;⑤术中测试ICD的起搏参数并诱发心室颤动,采用20J一次电击复律成功;⑥随访结果显示植入ICD后共发生室性心律失常事件426阵次,共启动抗心动过速起搏（ATP）治疗378阵次,成功304次（成功率80.42%）;高能量放电90次;有3次为窦性心动过速或房颤伴快速心室率所致的不恰当治疗。结论 ICD能有效治疗恶性室性心律失常,预防心脏性猝死;ATP是ICD治疗的有效方法;术后定期随访,及时优化ICD参数,合理选用辅助治疗,可减少不恰当治疗及提高ICD治疗的成功率。

Objective To evaluate the clinic effect of implanted cardioverter defibrillators （ICD） in patients with malignant ventricular arrhythmia. Methods Ninety-six patients had successfully been implanted ICD/CRT-D in our hospital from January 2005 to November 2009. All Patients were followed up regularly clinically and with interrogation of the device. The data were reviewed retrospectively. Results In these pati：ents of male 80 and female 16 with mean age of 14-79 （53±12.2） years old,there were 32 patients （33.3%） for primary prevention and 64 patients （66.6%） for secondary prevention. The underlying diagnoses were arrhythmogenic ringht ventricular eardiomyopathy （11）, hypertrophic cardiomyopathy （8）, ischemic heart disease （29）, dilated cardiomyopathy （ 13 ）, long QT syndrome （ 1 ）, Brugada syndrome （10） and ventricular tachycardia/fibrillation （23）, noncompaction of ventricular myocardium （1）. A total of 96 episodes of VF were induced at ICD implantation （single chamber 49, dual chamber 31 and CRT-D 16） and defibrillation threshold was 20 J. During following up, 426 ventricular arrhythmic episodes were recorded. 304 episodes were treated successfully with anti-tachycardia pacing （ATP）, 3 episodes of sinus tachycardia with atrial fibrillation were regarded as ventricular arrhythmic episodes and treated with cardioversion. Conclusions Implantation of ICD is a safe and effective approach to treat malignant ventricular arrhythmia and prevent sudden cardiac death. ATP is effective. It is important to follow up the patients and set appropriate parameters of ICD.