ICD不适当识别与治疗的原因与处理

Inappropriate detections or treatments of implantable cardioverter defibrillator

目的分析埋藏式心脏转复除颤器(ICD)不适当识别或治疗事件的原因,为避免不适当识别或治疗事件提供参考。方法回顾2008年至今42例ICD植入患者中发生不适当识别及治疗的临床资料。结果 34例随访18.5±11.7月,9例发生不适当识别或治疗事件,发生率26.5%,其中单腔ICD2台,双腔ICD 1台,CRT-D6台。4例发生不适当识别12次,7例发生不适当治疗29次,其中2例不适当识别及治疗共存。1例发生3次血流动力学稳定的室性心动过速(VT)事件,经抗心动过速起搏(ATP)失败后予电击治疗6次;3例发生快VT(FVT)事件,频率进入心室颤动(VF)区即给予电击共8次;1例右室电极脱位致P/R双计数误识别为VF11次,3次予电击,余充电后放弃;1例T波过感知误电击11次及误识别2次;1例电磁干扰误电击1次;1例干扰误识别为VF1次但充电后放弃;1例窦性心动过速误识别VT1次并予ATP治疗。结论 ICD术后不适当识别或治疗比较常见,规范程控随访,利于及时发现异常调整参数,优化程控治疗,可以减少不适当识别及电击。

Objective To analyze 41 imappropriate detection or treatment episodes among 9patients with implantable cardioverter defibrillator（ICD） and to investigate experience of avoiding imappropriate discharge.Methods Since 2008, 42 patients were implanted ICD, clinic materials of 9patients who subjected imappropriate detection or treatment were reviewed. Results 9 patients happened 41 imappropriate detection or treatment episodes,theincidenceis26.5%（5male）, the average follow-up time is 18.5±11.7 months and the mean age 56.9±13.1 years,included 2 single chamber ICD, 1 double chamber ICD and 6 CRT-D; 12 imappropriate detections in 4 patients and29 imappropriate discharges in 7 patients occurred（2 patient was double counted）. Among the total, there are 14imappropriate discharge events in 4 patients for sustain VT/FVT with stable hemodynamics,11 imappropriate discharges and 2 imappropriate detections in one patient for T wave oversensing, 3 imappropriate discharges in one patient for P/R wave double count, 1 imappropriate discharge for electromagnetic interference, 1 imappropriate detection forelectromagneticinterferenceand 1 imappropriated etection for sinus tachycardia. ConclusionsAfter ICD was implanted, the incidence of imappropriate detection or treatment episode is higher, it is necessary to strengthen programing follow-up for prompt abnormal discovery, the rapeutic change and sufficient ATP treatment without pain undera safe condition, it will profittore duce imappropriate dischargeand improve their quality of life.