29例心室“电风暴”回顾性分析

A retrospective analysis of 29 cases of ventricular electrical storm

目的总结分析我院收治的心室"电风暴"患者的病因、治疗及预后等。方法回顾性分析29例心室"电风暴"患者的病例资料、心电图资料等。结果所有患者中,病因以急性冠脉综合征最为多见16例(55.2%),其次为扩张型心肌病(17.2%),其他还包括三度房室阻滞、病毒性心肌炎、高血压性心脏病、致心律失常性右室心肌病和遗传性心律失常等。22例患者(75.9%)发作前有明显诱因。院内抢救成功率为82.8%。8例患者接受植入ICD或CRT-D治疗。2例患者行射频消融术。随访结果显示未行ICD或CRT-D的患者中有2例在院外猝死,植入ICD或CRT-D的患者有4例在随访期内仍有"电风暴"发作。结论急性心肌梗死和缺血状态,均为心室"电风暴"的主要病因及诱因。急性发作时应尽快进行电除颤和电复律以稳定血流动力学。药物治疗首选β受体阻滞剂,待病情稳定后可植入ICD。此外还可酌情考虑射频消融治疗。

Objective To report and summarize our experience on treatment for 29 cases with ventricular electrical storm. Methods Twenty nine patient＇s clinical data, ECGs and 24 hour dynamic electrocardiograms from 2006 to 2012 were analyzed retrospectively. Results Among these patients, the most common reason for ventricular electrical storm was acute coronary syndrome, and other cruises included dilated cardiomyopathy, three degree atrioventricular block, viral myocarditis, hypertensive heart disease, arrhythmogenic right ventricular cardiomyopathy, inherited arrhythmia. 22 patients could be found triggers before acute setting of arrhythmia. The successful rate of rescue is 82.8% in hospital. 8 patients were treated with implantable cardioverter-defibrillator. Two patients undergone radiofrequecy cather ablation. The follow-up showed 2 cases were found sudden death in non-ICD/CRT-D group, 4 cases were found recurrence of electrical storm in ICD/CRT-D group. Conclusion Acute myocardial infarction or myocardial ischemia was the major cause of electrical storm. Early defibrillation and cardioversion should be done immediately for stabilizing hemodynamic. 13-Receptor Blocker is the initial therapy for electrical storm. Radiofrequecy cather ablation for ventricular arrhythmias is safe and effective, and some patients have adequate interventions of ICD or CRT-D subsequently.