不同识别参数设置方法对植入型心律转复除颤器不恰当放电的影响

Programming single chamber implantable cardioverter defibrillators to prevent inappropriate shocks

目的探讨不同识别参数设置方法对植入型心律转复除颤器（ICD）不恰当放电的影响。方法选择2006年1月至2011年2月植入ICD患者84例，按照入院时间先后分为A、B两组，各42例。A组出院前经验设置室性心动过速／心室颤动与室上性心动过速鉴别参数；B组出院前进行ICD鉴别参数的标准设置。初级终点：死亡，起搏系统故障或为减少不恰当放电进行干预。次级终点：室上性心动过速误治疗，室上性心动过速正确识别，第1次对室上性心动过速误放电时间。结果A组1例患者因精神抑郁自杀死亡。B组2例患者出现电极绝缘微破裂征象。通过射频导管消融术、胺碘酮、增加识别频率上限以及增加识别间期数目可使ICD治疗减少。B组与A组相比能减少室上性心动过速的不恰当治疗（21．4％、61.9％，P〈0.05），增加室上性心动过速的正确识别（59．5％、31．0％，P〈0．05）。B组在植入ICD第4个月后能延长对室上性心动过速第1次不恰当治疗的时间（P〈0．01）。结论标准鉴别参数设置能减少ICD的不恰当治疗。

Objective To investigate the method to prevent inappropriate shocks for implantable cardioverter defibrillators （ICD）. Methods ICDs were implanted in 84 patients from January 2006 to February 2011. In 42 patients the parameters of ICD were setup by experiences （group A） and in onother 42 patients the discrimination parameters setup was standardized （group B）, The primary end points were death, pacemaker system fault or interventions to reduce inappropriate discharge.The second end points were SVT inappropriate therapy, SVT correct discrimination and the first time of SVT inappropriate therapy. Results In group A one patient committed suicide due to depression; in group B sign of microcrack of electrode insulation appeared in 2 cases. Through the radio frequency ablation, amiodarone, increasing recognition frequency limit and increase recognition inter-phase number made ICD therapy reduced. The percentage of correct diagnoses SVT in group B was higher than that in group A （61.9% vs 21.4%, P〈0.05）. The percentage of inappropriate shocks was lower in group B （31.0% vs 59.5%, P〈0.05）. The first time of SVT inappropriate shock was delayed within 4 months after discharge in group B （P〈0.01）. Conclusion Standardized discrimination parameters setup can reduce ICD inappropriate therapy.