植入心律转复除颤器患者室性心律失常和放电事件的相关分析

Analysis of Ventricular Arrhythmias and Shock Events in Patients with Implantable Cardioverter-Defibrillator

【目的】分析植入心律转复除颤器(ICD)患者在一级或二级预防中发生室性心律失常和放电治疗情况及相关因素。【方法】对2004年3月至2012年9月在中山大学附属第一医院植入了ICD的92例患者进行程控随访,结合患者的临床资料进行回顾性分析。【结果】92例患者,其中ICD一级预防45例,二级预防47例,共进行了423人次的程控随访,平均随访时间(27.6±21.8)个月。有37.8%的一级预防患者出现了室速/室颤(VT/VF),平均2.53次/人年;28.9%的患者给予了放电治疗,平均0.44次/人年。在二级预防中有59.6%的患者出现VT/VF,平均4.99次/人年,其中有47.9%需要放电治疗,平均为1.41次/人年。所有患者中,有46例ICD发生放电(50.0%),其中恰当放电的35例(38.0%),不恰当放电的11例(12.0%)。总计放电334次,其中恰当的放电治疗198次(59.3%),不恰当的放电治疗136次(40.7%)。不恰当放电原因包括:房颤92次(67.6%),阵发性室上性心动过速32次(23.5%),ICD异常感知12次(8.8%)。有房颤病史的患者发生VT/VF的概率以及误放电的概率均高于无房颤病史的患者,差异有统计学意义(P<0.05)。【结论】ICD在心脏性猝死的一级预防能给患者带来获益;房颤既是ICD不恰当放电的主要原因,也是提示VT/VF高发的指标。

[Objective] To analyze the ventricular arrhythmias and shock events and their related factors in patients with implantable cardioverter-defibrillator （ICD）. [Methods] Ninety-two patients were implanted ICD in The First Affihated Hospital of Sun Yat-sen University from Mar 2004 to Sep 2012. All patients were followed-up regularly. The data combined with the clinical information of patients were analyzed retrospectively. [ Results ] Ninety-two patients were followed-up for 27.6＋21.8 months averagely. 45 cases were primary prevention, 47 cases were secondary prevention. 423 person-time follow-up were conducted. 37.8% primary prevention patients appeared ventricular tachycardia/ventricular fibrillation （VT/VF）, 2.53 times/person-year averagely; 28.9% patients in that were given the shock treatment, 0.44 times/person-year averagely. 59.6% secondary prevention patients appeared VT/VF, 4.99 times/person-year averagely; 47.9% patients in that were given the shock treatment, averagely 1.41 times/person- year. In all patients, 46 cases have ICD shock events （50.0%）, in which appropriate shock 35 cases （38.0%） and inappropriate shock 11 cases （12.0%）. Total shock are 334 times, in which appropriate shock 198 times （59.3%） and inappropriate shock 136 times （40.7%）; Inappropriate shock reasons include： Atrial fibrillation 92 times （67.6%）, supraventricular tachycardia 32 times （23.5%）, abnormal sensing 12 times （8.8%）. The probability of both VT/VF and inappropriate shock events in patients with a history of atrial fibrillation are higher than patient without atrial fibrillation history （P 〈 0.05）. [ Conclusion] ICD primary prevent was benefit to patients to reduce sudden cardiac death （SCD） ; atrial fibrillation was not only the main reason of inappropriate shock, but also the hint to high incidence of VT/VF.