肥厚型心肌病高危患者植入埋藏式心律转复除颤器的疗效观察

A Clinical Observation of Implantable Cardiac Defibrillator in High-risk Patients of Hypertrophic Cardiomyopathy

目的：观察肥厚型心肌病（HCM）高危患者植入埋藏式心律转复除颤器（ICD）的疗效。 方法：系统收集我院2004-01至2013-10期间31例植入ICD的HCM患者的临床资料并进行随访，随访包括门诊复诊、ICD程控及电话随访。根据ICD有无正确识别及治疗，分析放电的相关性。 结果：31例患者平均年龄（54.9±15.0）岁，病史年限（13.5±11.5）年，植入ICD前出现晕厥或晕前反应26例，经电复律或药物复律22例，心肺复苏生存者3例。有HCM家族史7例，其中一级亲属猝死3例。31例患者最大左心室壁厚度（21.0±5.2）mm，5例有左心室流出道压差现象。ICD一级预防5例，二级预防26例。31例患者平均随访时间（37.9±29.0）个月，随访期间41.9%（13/31）患者在植入ICD后平均2年（0.5年～5年）发生ICD正确治疗事件。ICD正确识别共放电63次，平均2.1次/人，5例发生超速起搏抑制治疗共64次，平均2.0次/人，发生放电事件均为二级预防患者。6.7%患者出现并发症，包括电极移位调整1例，电极感知故障1例。与无放电患者比较，有放电患者的年龄更小、左心室流出道压差及心室颤动发生率更高，复律率更高，差异有统计学意义（P〈0.05）。有放电患者及无放电患者中服用β受体阻滞剂和非二氢吡啶钙拮抗剂的患者比例差异无统计学意义（P〉0.05）。有放电患者中安装单腔ICD与安装双腔ICD的患者比例差异无统计学意义（P〉0.05） 结论：年轻、既往有晕厥或心室颤动史的HCM患者在服用β受体阻滞剂同时更能从ICD植入中获益。

Objective： To observe the efficacy of implantable cardiac defibrillator （ICD） in the high-risk patients of hypertrophic cardiomyopathy （HCM）. Methods： A total of 31 HCM patients with ICD implantation in our hospital from 2004-01 to 2013-10 were enrolled. The follow-up study included the hospital records, clinical visit and telephonic interview. Based on identification and treatment, the relevant ICD shocks were analyzed. Results： The patients’ mean age was at （54.9 ± 15） years and the history of disease was at （13.5 ± 11.5） years. There were 26 cases suffered from syncope or pre-syncope before ICD implantation and 22 cases had the cardio-version by electrical treatment or medication including 3 survivors from cardiac arrest. There were 7 patients with family history of HCM, 3 had sudden cardiac death in their first-degree relatives. The maximum left veutricalar wall thickness of 31 patients was at （21.0 ± 5.2） mm and 5 with left ventricular outflow obstruction. There were 5 patients received ICD implantation for primary prevention and 26 for secondary prevention. The average follow- up time was （37.9 ± 29.0） months, and 41.9% （13/31） of patients had ICD correct treatment at the mean of 2 （0.5-5） years after ICD implantation. In patients with secondary prevention, ICD conducted 63 shocks with correct identification at the mean of 2.1 shocks/person, and 64 episodes of anti-tachycardia pacing recorded in 5 patients at the mean of 2.0 episodes/person. There were 6.7% of patients with complications including 1 of electrode displacement and 1 of electrode sensing fault. The patients with ICD discharge had the younger age, higher incidences of left ventricular outflow obstruction, ventricular fibrillation and higher rate of cardio-version than those without ICD discharge, P〈0.05. The patients usingβ-blocker and nondihydropridine calcium channel blolcker were similar for discharge or no discharge, P〉0.05. Conclusion： HCM patients with the younger age, history of syncope or ventricular fibrillation and usingβ-blocker would be more beneficial for ICD implantation.