埋藏式心脏复律除颤器植入患者室性心动过速电风暴的临床特点

Clinical features of electrical storm of ventricular tachycardia of patients with implantable cardioverter defibrillator

目的分析埋藏式心脏复律除颤器/心脏再同步治疗除颤器(ICD/CRT-D)植入患者术后室性心动过速电风暴(ES)的临床特点和治疗措施。方法对89例植入ICD/CRT-D的患者进行规律随访,采集相关数据,分析其室性心动过速ES的发作特点、相关危险因素及相应的治疗结果。结果在随访期内,共有19例(21.3%)患者至少发生1次ES,其中11例患者经历2次以上的ES。14例(73.7%)患者首次ES发生在ICD术后1年内。患者发生ES的心律失常形式主要是单形性室性心动过速(68.4%),大部分患者(68.4%)ES发作没有明确的诱因。多因素logistic回归分析表明,ICD作为心脏性猝死二级预防是ES发生的独立危险因素(P=0.014 2)。在冠状动脉粥样硬化性心脏病和扩张型心肌病患者中植入CRT-D的患者与植入ICD的患者相比较少发生ES(P=0.033)。ES组死亡率未见明显升高。结论在植入ICD的患者中,ES是常见的现象;因心脏性猝死二级预防而植入ICD的患者ES的发生率显著高于一级预防的患者,冠状动脉粥样硬化性心脏病和扩张型心肌病患者中植入CRT-D的患者较少发生ES。

Objective To analyze the clinical features and treatment of electrical storm（ES） of ventricular tachycardia after operation for patients with implantable cardioverter defibrillator/cardiac resynchronization therapy defibrillator（ICD/CRT-D）.Methods Eighty-nine patients with ICD/CRT-D were followed up regularly to collect relevant data and analyze the onset characteristics of electrical storm of ventricular tachycardia,related risk factors,and corresponding treatment outcomes.Results Nineteen patients（21.3%） experienced at least one episode of ES during the follow up.Among them,11 patients experienced two or more episodes of ES.14 patients（73.7%） experienced the first episode of ES within one year after ICD operation.Monomorphic ventricular tachycardia（VT）（68.4%） was the main arrhythmic type of ES and no obvious causes were identified for the onset of ES of most patients（68.4%）.The multivariate logistic regression analysis showed that as the secondary prevention of sudden cardiac death,IC D was an independent risk factor of the onset of ES（P = 0.014 2）.The onset times of ES of patients with coronary atherosclerotic cardiopathy and dilated cardiomyopathy implanted with CRT-D was less than those of patients implanted with ICD（P = 0.033）.The mortality rate of ES group was not significantly higher.Conclusion ES is common for patients with ICD.The incidence of ES of patients with IC D for secondary prevention of sudden cardiac death is significantly higher than that of patients for primary prevention.The onset of ES of patients with coronary atherosclerotic cardiopathy and dilated cardiomyopathy who have implanted the CRT-D is less common.