埋藏式心脏转复除颤器不适当识别或治疗事件原因分析及处理

Cause analysis of imappropriate detection or treatment episodes 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。方法:回顾2008年至2013年42例ICD植入患者发生不适当识别或治疗的临床资料。结果:34例随访(18.5±11.7)个月,9例(26.5%)共发生41次不适当识别或治疗事件(其中单腔ICD 2台,双腔ICD 1台,CRT-D 6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例不适当识别或治疗共存。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)失败后给予电击治疗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VF 11次,3次给予除颤,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VF 1次,但充电后放弃;1例窦性心动过速误识别为VT 1次并给予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。

Aim：To analyze the causes of imappropriate detection or treatment of implantable cardioverter defibrillator （ICD）.Methods：Since 2008 to 2013,42 patients were implanted ICD,clinic materials of 9 patients who subjected imap-propriate detection or treatment were reviewed .Results：Nine（26.5%） patients happened in 41 imappropriate detection or treatment episodes,the average follow-up time was （18.5 ±11.7） months.Twelve imappropriate detections in 4 patients and 29 imappropriate discharges in 7 patients occurred（2 patient was double counted ）.Among the total,there are 14 imap-propriate 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 for electromagnetic inter-ference and 1 imappropriate detection for sinus tachycardia .Conclusion：After ICD was implanted ,the incidence of imap-propriate detection or treatment episode is higher , it is necessary to strengthen programing follow-up for prompt abnormal discovery ,therapeutic change and sufficient ATP treatment without pain under a safe condition ,it will profit to reduce imap-propriate discharge and improve the quality of life .