植入植入型心律转复除颤器后慢频率室性心动过速的治疗策略

Slow ventricular tachycardia in patients with implantable cardioverter defibrillator

目的探讨慢频率室性心动过速（室速）在植入植入型心律转复除颤器（ICD）患者中的发生率及治疗策略。方法入选浙江绿城心m管病医院心内科白2008年1月至2014年12月植入的除颤器[单、双腔ICD及心脏再同步治疗除颤器（CRT—D）]患者353例。所有一级预防和二级预防患者按既定不同方案设置参数。术后室速发作负荷≥10％且频率〈160次／rain定义为需优化参数治疗的慢频率室速，分为A组1次抗心动过速起搏（ATP）为低能量电击组；B组3次ATP为高能量组。结果所有患者中有102例（29％）发生室性心律失常。ICD参数需优化治疗的有27例，共发生慢频率室速876次，A组共有422阵室速，B组有454阵室速。A组ATPl次成功率为67％（282／422）与B组ATP3次71％（322／454）差异无统计学意义（JP=0．12）；B组ATP3＋20J成功率89％（404／454）较A组ATP1＋5J组79％（333／422）成功率高（P=0．04）。A组ATP1＋5J治疗成功率与自身ATPl次相比有明显提高（P=0．03）；B组ATP3＋20J比单纯ATP3成功率高（P=0．011）。结论慢频率室速存植入ICD患者中发生率较高，尤其是大剂量服用胺碘酮及B受体阻滞剂的患者。对于负荷较重的慢频率室速患者，1次ATP治疗＋小能量电击治疗，可能获益最大。

Objective This study aims to assess the incidence of slow ventricular tachycardia （VT） and its treatment strategies in implantable eardioverter defibrillator（ICD） patients. Methods All 353 patients with including single and dual-chamber ICD or cardiac resyncronization therapy defibrillator（CRT-D） were en- rolled in this study in Zhejiang Greentown Cardiovascular Hospital from January 2008 to December 2014. Pa- tients had a 3-zone detection configuration： monitoring non treatment（ ventricular rate 120 to 180 bpm）, anti- tachyarrhythmia pacing（ATP）-low energy shock zone（ ventrieular rate 180 to 200 bpm）, and a ventricular fi- brillation zone.When VT burden was more than 10% and the ventricular rate was less than 160 bpm it needed to optimize the parameters to treat the slow VT.Patients were divided into group A ATP-low energy cardioverter groups （ ATP 1 time-5 J- 10 J-maximum energy shock ） ; group B ATP-high energy （ ATP 3 times- 20 J-the largest energy）. Results VT occurred in 102 （ 29% ） patients, slow VT occurred in 46 （ 13.1% ） patients. Parameters optimization was carried for slow VTs in 27 （ 7.6% ） patients. One time ATP therapy success rate was 67% in group A,ATP＋5 J success rate was 79%,ATP＋5 J＋10 J was 92%.Group B 3 times ATP success rate was 71% ,ATP 3 times＋20 J was 89%. Conclusion The slow VT had a high incidence in patients with ICD,espe- eially in patients who took up large doses of amiodarone and β receptor blockers.For patients with heavier bur- den of slow VTs, ATP and small energy electric shock therapy may have greater benefit.