老年人埋藏式心律转复除颤器误放电原因分析及处理

Analysis of causes of inappropriate discharge of an implantable cardioverter defibrillator in elderly patients

目的 分析老年患者埋藏式心律转复除颤器（ICD）误放电发生原因并探讨相应的处理方法. 方法 对植入ICD的患者进行随访,应用体外程控仪记录误放电发生时的事件情况并进行分析. 结果 95例患者共随访235例次/年,出现ICD误放电16例,误放电原因包括心室误感知7例（43.7％）,室上速误认为室性心动过速4例（25.0％）,其他误放电5例（31.3％）,包括ICD电极磨损2例（12.5％）,肌电干扰、肌肉电刺激仪、电极磨损合并肌电干扰各1例（各占6.3％）.经程控及无创处理后可减少及避免再次误放电11例,其中1例经程控后出现感知低下,未能正确识别心室颤动,经体外除颤后转复；余5例经有创处理好转. 结论 植入ICD患者可出现多种类型的误放电,可根据不同ICD进行相应参数调整,在保证ICD感知灵敏度的同时减少误放电.

Objective To analyze the causes of inappropriate discharge of implantable cardioverter defibrillator （ICD） in elderly patients and to discuss the corresponding solutions.Methods Totally 95 elderly patients with ICD were collected.They were followed up and the inappropriate ICD discharges were recorded and analyzed.Results All patients were followed up for 235 times/year totally.There were 16 patients with inappropriate ICD discharges.The causes of inappropriate ICD discharges included ventricular oversensing in 7 patients （43.7%）,supraventricular tachycardia misclassified into ventricular tachycardia in 4 patients （25.0%）,electrode fracture in 2 patients （12.5%）,and electromyogram （EMG） interference,electromagnetic interference and electrode fracture with EMG interference in 1 patients respectively （6.3% each）.11 inappropriate ICD discharges were reduced and avoided by reprogrammed and noninvasive treatment in 16 patients.1 patient with the underdetected ventricular fibrillation after reprogramming and the problem was solved by external defibrillation.The other 5 patients got better by the invasive treatment.Conclusions Different causes account for inappropriate discharges in patients with ICD.Reprogramming the corresponding parameters in different ICD can reduce or avoid inappropriate discharges without affecting the sensitivity of ICD.