植入带有家庭监测系统的心律转复除颤器20例临床随访及评价

Evaluation of implantable cardioverter defibrillator therapy with Home Monitoring system-clinic fol-low-up in 20 patients

目的对我院20例植入带有家庭监测系统的心律转复除颤器（ICD）患者进行门诊及家庭监测系统随访。探讨家庭监测系统对植入ICD患者电极导线及脉冲发生器安全性评价及对包括房性心律失常、恶性室性心律失常在内的临床事件的早期发现及干预效果。方法收集20例2010年6月至2011年11月在我院植入带有家庭监测系统的ICD患者的临床特征、植入信息及通过家庭监测网站系统和门诊常规随访结果，将随访结果进行回顾性总结分析。结果20例患者随访117～644（332．90±175．25）d，在随访过程中，累计有6例患者有室性心律失常事件发生，其中有5例患者成功接受ICD，占全部患者的25％。1例患者因快速心房颤动（房颤）被误识别为心室颤动（VF）而进行电除颤。5例成功接受ICD治疗的患者中有1例患者曾因房性心动过速（房速）误识别为室性心动过速（VT）而进行电除颤，误识别及误放电的发生率为9．1％。除去误识别及误放电外，所有患者共发作室上性心动过速（SVT）238次，VT/VF20次，其中VT7次（35％），VF13次（65％）。VT发作均由抗心动过速起搏治疗（ATP）终止，共发放26阵ATP，成功转复7次，ATP转复率27％，VT治疗成功率100％。VF导致充电开始13次，其中10次在ICD结束充电前自行终止，3次在放电治疗后成功转复，ICD治疗成功率100％。20例患者中无1例死亡。结论通过家庭监测网络系统，不仅可以对ICD患者电极导线及脉冲发生器的正常运转进行有效监控，还可以在患者出现自觉症状前尽早发现患者潜在的恶性心律失常事件和心功能的恶化，并给予及时处理，以避免ICD事件的发生和治疗，从而给患者带来更大的获益。

Objective To evaluate the safety and effectiveness of implantable cardioverter defibrillator （ICD） therapy with Home Monitoring system in clinic patients. Discussion ：①Safety evaluation of Home Monito-ring system for patients with ICD electrode wire and pulse generator. ②Early detection and intervention effect of Home Monitoring system including atrial arrhythmias, malignant ventricnlar arrhythmia to clinical events. Meth- ods Clinical data were collected and analyzed in 20 patients implanted Home Monitoring system with ICD, from June 2010 to November 2011 in our hospital. Results The mean followed-up period was 333 days （ 117 ± 644 days）. During the foUow-up period, five patients accepted ICD therapy successfully. In addition, rapid atrial fibrillation was mistakenly identified as VF and shock was delivered in one patient. Beside of error identi-fication and mistakenly discharge, SVT attacks （total 238 times） were observed in all patients, VT/VF 20 times, including VT 7 times 35%, VF 13 times by 65%. VT attacks were all terminated by antitachycardia pacing（ATP）, total release 26 array ATP, successfully converting 7 times, ATP converting rate 27%, VT treatment rate was 100%. VF leads to start charging 13 times, including 10 times in the end before charging VF ICD to terminate, 3 successful converting, ICD therapy rate was 100%. There was none of death. Conclusion Through the Home Monitoring network system, we could effectively monitor patients with ICD electrode wire and pulse generator, and could early detect.