6例埋藏式心脏转复除颤器频繁电击分析与处理

Analyze of frequent discharge events among 6 patients with implantable cardioverter defibrillator

目的分析6例埋藏式心脏转复除颤器（ICD）患者术后频繁电击的临床特点。方法回顾2008年至今42例ICD植入患者中6例术后频繁电击的临床资料。结果6例发生频繁电击（发生率14．3％），随访8～38个月，死亡1例。1例CRT-D患者半年内发生6次ICD电风暴，多为反复发生室性心动过速（VT）、快VT（FVT），抗心动过速起搏（ATP）无效升级为电击治疗或者ATP诱发FVT、心室颤动（VF）而行电击治疗，首次电风暴9个月后死于顽固心力衰竭；1例左上腔植入单腔ICD患者出现3次血流动力学稳定的VT事件频率进入VF诊断区直接电击治疗6次且无效；1例单腔ICD患者因T波过感知致11次误放电；1例双腔ICD患者出现3次血流动力学稳定的VT事件，ATP失败后电击治疗6次且无效，此3例均经优化程控后无电击事件。1例CRT—D患者因右室电极脱位至三尖瓣环处致P、R双计数误识别为3次VF并予电击，经再次手术复位后无类似事件。1例CRT—D患者极短期内因2次VF事件及1次VT事件，10阵ATP无效而先后3次电击治疗，优化药物及程控后无电击事件。结论ICD术后频繁电击病因及诱因治疗是预防发生和及时终止的基础，优化药物及程控治疗可降低对电击治疗的需求及误放电的发生，必要时手术调整或导管消融。

Objective To analyze frequent discharge events among 6 patients with implantable cardioverter defibrillator （ICD）. Method Since 2008, 42 patients were implanted ICD, clinic materials of 6 cases with frequent discharge events were reviewed and analyzed. Results （1）General materials： 34 patients were followed up, 6 cases （3 males）had been subjected frequent discharge events（ the incidence was 14.3% ）, aged from 38 to 67 years, included 2 CRT-D for dilated cardiomyopathy with VT/VF, 1 single chamber ICD for long Q-T syndrome with PVC/VT/VF, 1 single chamber ICD for idiopathic ventricular fibrillation, 1 double chamber ICD and 1 CRT-D for ischemic cardiomyopathy with VT;（2）Frequent discharge events： One patient with CRT-D experienced 17 discharges in half a year for repeated and non-silent VT/FVT after failed ATP, died of obstinate heart failure 9 months after first discharge event; One with single chamber ICD surffered from 6 ineffective discharges for 3 sustain VT events that matched VF frequency diagnostic criteria in a short time ; One with single chamber ICD underwent 11 imappropriate discharges for T wave oversensing; One with double chamber ICD encountered 6 ineffective discharges for 3 sustain VT events after failed ATP in 40 minutes ; One with CRT-D happened 3 imappropilate charges for VF events that caused by P/R-wave double count ; The other with CRT-D ） had been subjected 3 discharges for 2 VF and 1 VT after 10 sequences inefficient ATP in several hours. Among the survivors, one received second operation,the others received optimizing drug therapy and/or parameter re-programing, after fellow-up, frequent discharge event hadn＇t occured; Conclusion After ICD was implanted, frequent discharge is an emergency event, we should promptly search the causes and treat, it is important to optimize drug therapy and parameter re-programing, sometimes operative correction will be unavoidable.