心脏再同步化治疗术后脉冲发生器电池提前耗竭原因分析

Analysis of possible reasons of premature battery depletion in patients implanted with cardiac resynchronization therapy-defibrillator device

目的分析心脏再同步化-心脏复律除颤器(CRT-D)脉冲发生器电池提前耗竭的可能原因。方法回顾2005年1月至2009年12月于我院行CRT-D治疗的33例患者的临床及起搏器程控资料,并对5例(15.2%)出现脉冲发生器电池提前耗竭的患者资料进行分析。结果 5例患者均为男性,平均年龄55岁,所使用的起搏器型号分别为Medtronic InsyncⅢMarquis 7279(1例),InsyncⅢMarquis protect 7285(2例)和St Jude Epic+HF-V350(2例);使用年限分别为33、44、35、41和47个月;起搏模式分别为VVI、DDD、DDD、DDD和DDD;心室起搏比例分别为99%、99%、93%、86%和96%;左心室输出电压(脉宽)分别为4.0 V(0.4 ms)、3.5 V(0.6 ms)、3.5 V(0.4 ms)、5.0 V(0.4 ms)和5.0 V(0.7 ms)。5例患者的电击治疗次数分别为4、16、33、6和0次。结论 CRT-D脉冲发生器电池提前耗竭并不少见。因脉冲发生器寿命受多种因素的影响,故导致其电池提前耗竭的原因也多样。CRT-D术后定期随访,在保证安全的前提下,尽可能减少输出电压,降低心率,减少放电治疗,以延长脉冲发生器的使用寿命。

Objective To analyze the possible reasons of premature battery depletion in patients implanted with cardiac resynchronization therapy-defibrillator （ CRT-D） device. Methods All patients with CRT-D device implanted between 2005 and 2009 at the People＆#39;s Liberation Army General Hospital were followed up. All patients with premature battery depletion were studied further. Results Five cases （15. 2%, mean age 55 years） with premature battery depletion were identified among 33 patients implanted with CRT-D device. The longevity of 5 premature depletion devices were as follows：33, 44, 35, 41 and 47 months （median 40 months）. The pacing mode were VVI, DDD, DDD, DDD and DDD, and percentage of ventricular pacing were 99%, 99%, 93%, 86% and 96%. The output of left ventricular lead were 4. 0 V （0. 4 ms）, 3. 5 V（0. 6 ms）, 3. 5 V （0. 4 ms）, 5. 0 V （0. 4 ms） and 5. 0 V （0. 7 ms）. Among the above patients, two suffered from frequent inappropriate shocks. Conclusions The incidence of premature battery depletion is 15. 2% in patients implanted with CRT-D device in our center. No common mechanism has been identified for this failure. Close monitoring of battery voltage and individual parameter alteration are required in patients with these devices.