植入型心律转复除颤器患者的电风暴事件

Electrical storms in patients with an implantable cardioverter defibrillator

目的本文旨在观察植入型心律转复除颤器（ICD）植入后电风暴（ES）的发生率和临床特征。方法回顾性分析2003年1月至2010年10月在阜外医院植入ICD的134例患者术后的临床治疗和ICD程控资料，比较发生ES和未发生ES的患者基础心脏病、心功能、药物治疗和预后的差异。结果17．4％的ICD患者发生过Es事件，其中70％患者事件数≥2，89．5％的Es是由于室性心动过速（VT）引起的。与未发生Es的患者相比，发生Es患者的左心室内径更大[（56．2±9．5）mm对（60．8±7．9）mm，P=0．03]；左心室射血分数（LVEF）更低（0．48±0．13对0．40±0．09，P=0．04），B受体阻滞剂使用的比例更低（91．8％对71．8％，P=0．01）。在随访期间，ES组患者死亡或心脏移植的发生率显著高于未发生ES的患者。结论Es在1CD植入术后患者中并不罕见且常反复发生，心功能低下、B受体阻滞剂应用不足会增加ES的风险；ES患者中死亡及需要心脏移植的比例增高。

Objective The purpose of this study was to determine the incidence and risk factors of electrical storms （ES） in patients who received implantable cardioverter defibrillator （ICD）. Methods We ret- rospectively assessed 134 ICD patients＇ medical records and ICD programmed records. ES was defined as the occurrence of three or more ventricular tachyarrhythmia episodes that needs ICD therapy. Results seventeen point four percent of the patients experienced at least one ES episode. In most ES cases, the index arrhythmia was ventricular tachycardia. Compared with non-ES patients, ES patients had depressed left ventricular ejection fraction（ LYEF 0.48±0. 13 vs. 0. 40±0. 09 ,P=0. 04） ,enlarged left ventricular diameter[ （56. 2±9.5） mm vs. （60. 8±7.9 ） mm, P = 0. 03 ], insufficient use of β-blocker （91.8% vs. 71.8%, P = 0.01 ）. And ES episode could increase the risk of combined incidence of mortality and heart transplantation. Conclusion ES events are not rare in a ＇ real-world＇ patient population with ICDs. It is most likely to occur in patients with lower LVEF, and insufficient use of B-blocker would increase the risk of ES.