全皮下植入式心律转复除颤一例并文献回顾

Subcutaneous implantable cardioverter defibrillator:one case report and literature review

目的结合病例评价全皮下植入式心律转复除颤器(subcutaneous implantable cardioverter defibrillator,S-ICD)在临床实际应用中预防心脏性猝死(sudden cardiac death,SCD)的有效性及安全性。病例介绍1例33岁反复发作室性心动过速的男性患者因既往三尖瓣机械瓣置换术无法经静脉途径植入传统右心室除颤电极导线,于2014年12月在中国医学科学院阜外医院行S-ICD植入术。患者于全麻下植入S-ICD,设定心率大于190次/min为放电治疗区,心率在170次/min至190次/min之间为条件治疗区。随访患者植入S-ICD后3个月进行随访,随后每年随访1次,并嘱有不适或放电时及时就诊。观察患者随访过程中S-ICD的事件记录、感知和治疗情况以及并发症的发生情况。随访期间共发生持续性室性心动过速、心室颤动8次,其中4次事件在1次电除颤后成功转复,另外4次在2次电除颤后转复,未发生不恰当放电情况,无并发症发生。后患者因心力衰竭行心脏移植,移除S-ICD装置,随访期持续1年。结论S-ICD具有良好的安全性和有效性,在一定适应证范围内应用前景广阔,在预防SCD方面有独特的应用价值。

Objective To evaluate the effectiveness and safety of subcutaneous implantable cardioverter defibrillator(S-ICD)on prevention of sudden cardiac death(SCD)in the clinical application with a case report.Clinical Features A 33-year-old male patient presented with recurrent ventricular tachycardia.He could not be implanted with the traditional implantable cardioventer defibrillator(ICD)electrode for the history of tricuspid mechanical valve replacement.The patient underwent S-ICD implantation in the Fuwai Hospital Chinese Academy of Medical Sciences.The patient underwent the procedure under general anesthesia with heart rate greater than 190 beats/min as discharge treatment area and heart rate between 170 beats/min to 190 beats/min as the condition treatment area.Follow-up The patient was followed up for 3 months after the procedure.And then,he was followed up once a year.In addition,the patient was told to come back to the hospital for any symptoms or discharge to observe the events,sense,treatment and complications of S-ICD during the follow-up period.During the follow-up period,continuous ventricular tachycardia and ventricular fibrillation ocurred eight times.Four of these were successfully converted after once defibrillation,and 4 were converted after twice defibrillations,without improper discharge and complication.After cardiac transplantation for heart failure,the patient underwent removal of S-ICD and was followed up for one year.Conclusion S-ICD is safe and effective for the prevention of SCD,which has a broad application prospect in the scope of certain scenarios.