经静脉安置埋藏式心脏复律除颤器的临床应用

Clinical Application of Transvenous Implantable Cardioverter Defibrillator.

对 5例恶性室性心律失常患者安置埋藏式心脏复律除颤器 (ICD)治疗。 5例均为男性 ,年龄 39～ 74岁。冠心病 (1例为前壁心肌梗死 ) 3例 ,心肌病、扩张型心肌病伴左束支阻滞及Ⅰ度房室阻滞各 1例。药物治疗效果不佳。3例冠心病及 1例心肌病患者置入单腔ICD ,扩张型心肌病置入双腔ICD。 5例均成功置入ICD。平均起搏阈值0 .5 2V ,平均R波振幅 15 .7mV。随访 6～ 36个月 ,4例患者出现快频率室性心动过速 (简称室速 ) ,经抗心动过速起搏及低能量电击转复为窦性心律 ,平均电击能量 5 .4J。 1例发生室上性心动过速导致ICD误放电治疗 ,经重新设置室速频率窗口 ,未再出现误放电。结论 :ICD能有效转复恶性室性心律失常 ,双腔ICD因增加了心房电极 ,在改善血液动力学、预防房性及室性快速心律失常。

Five patients with ventricular tachyarrhythmias were treated by implantable cardioverter defibrillator(ICD) .Five were all men aged 39～74 years.Three were coronary heart disease(one was anterior myocardial infarction).One was cardiomyopathy.One was dilated cardiomyopathy who was accompanied by left bundle branch block and first degree atrioventricular block.Antiarrhythmic drug therapy was unsuccessful.The ICD were implanted transvenously.Four were single chamber ICD,One was dual chamber ICD.Results:All operations were performed successfully.The average pacing threshold and amplitude of R wave was 0.52 V and 15.7 mV.In 6～36 months of follow up,the fast ventricular tachyarrhythmia in four patients was treated by ATP and shock.The average energy was 5.4 J.Fault shock occurred due to superventricular tachycardia in one single chamber ICD patient which being converted to sinus rhythm.After reseting it,fault shock disappeared.Conclusion:The dual chamber ICD offers several additional benefits that improves hemodynamic,prevents atrial or ventricular tachyarrhythmias,decreases inappropriate ICD therapy.