Background: The value of an implantable cardioverter defibrillator(ICD) for primary prevention in dilated cardiomyopathy(DCM) is unclear, as randomized trials could not show a survival benefit compared to drug therapy...Background: The value of an implantable cardioverter defibrillator(ICD) for primary prevention in dilated cardiomyopathy(DCM) is unclear, as randomized trials could not show a survival benefit compared to drug therapy. It has not been investigated if patients with a very poor left ventricular function(LVEF) could profit from an ICD. Methods: Consecutive patients with DCM who received an ICD between December 1996 and November 2003 were included in this analysis. Patients were divided in group A(secondary prevention) and group B(primary prevention). Both groups were stratified in subgroups with left ventricular ejection fraction(LVEF) below and above 20% . Results: Fifty eight patients were included(male 50, age 56.4± 12.7 years). Follow-up was 34± 19 months. There was no difference regarding death(18% vs. 11% ), but significant differences(p value< 0.05) regarding any adverse events(55% vs. 22% ), any ICD intervention(48% vs. 17% ) and ICD interventions for life-threatening arrhythmias(27% vs. 0% )between group A and B. LVEF was not predictive for events in group A, whereas in group B only patients with a LVEF< 20% had events(p value 0.02). Over time there was an increase of the LVEF of more than 15% determined by echocardiography in 36% of patients, significantly more often in group B. Conclusions: Indication for primary prevention with an ICD in DCM should be made with caution. Larger studies are needed to determine if patients with LVEF of< 20% might benefit from an ICD.展开更多
图QT间期明显延长为特征的一组症候群，易产生室性心律失常，尤其是尖端扭转型室性心动过速，严重者可致心源性猝死。LQTS按病因可分为获得性和遗传性两种类型。获得性LQTS通常与心肌局部缺血、心动过缓、电解质异常和应用某些药物有关...图QT间期明显延长为特征的一组症候群，易产生室性心律失常，尤其是尖端扭转型室性心动过速，严重者可致心源性猝死。LQTS按病因可分为获得性和遗传性两种类型。获得性LQTS通常与心肌局部缺血、心动过缓、电解质异常和应用某些药物有关；遗传性LQTS又有两种形式，包括Romano-Word（Rws）综合征和Jervell and lange-Nielsen（JLN）综合征。RWS综合征最常见，为常染色体显性遗传，后代患病的几率为50％。遗传性心律失常的恶性心律失常发生率高，药物治疗效果多不理想，常以反复晕厥、猝死为主要临床表现，植入型埋藏式心脏复律除颤器（Implanable Cardioverter Defib-rillator，ICD）是目前最有效、最可靠的治疗手段，可最大限度地挽救患者的生命[1]。循证医学实践证明，LQTS患者如抗肾上腺素能治疗（如8受体阻断剂）、左侧心交感神经切除术、药物治疗效果不理想且反复晕厥，则需要辅以起搏器或ICD治疗[2]。2013年7月本科收治1例13岁女童，为先天性LQTS，在应用β受体阻断剂倍他乐克控制心率后植入ICD进行治疗，现将护理体会报告如下。展开更多
文摘Background: The value of an implantable cardioverter defibrillator(ICD) for primary prevention in dilated cardiomyopathy(DCM) is unclear, as randomized trials could not show a survival benefit compared to drug therapy. It has not been investigated if patients with a very poor left ventricular function(LVEF) could profit from an ICD. Methods: Consecutive patients with DCM who received an ICD between December 1996 and November 2003 were included in this analysis. Patients were divided in group A(secondary prevention) and group B(primary prevention). Both groups were stratified in subgroups with left ventricular ejection fraction(LVEF) below and above 20% . Results: Fifty eight patients were included(male 50, age 56.4± 12.7 years). Follow-up was 34± 19 months. There was no difference regarding death(18% vs. 11% ), but significant differences(p value< 0.05) regarding any adverse events(55% vs. 22% ), any ICD intervention(48% vs. 17% ) and ICD interventions for life-threatening arrhythmias(27% vs. 0% )between group A and B. LVEF was not predictive for events in group A, whereas in group B only patients with a LVEF< 20% had events(p value 0.02). Over time there was an increase of the LVEF of more than 15% determined by echocardiography in 36% of patients, significantly more often in group B. Conclusions: Indication for primary prevention with an ICD in DCM should be made with caution. Larger studies are needed to determine if patients with LVEF of< 20% might benefit from an ICD.
文摘图QT间期明显延长为特征的一组症候群，易产生室性心律失常，尤其是尖端扭转型室性心动过速，严重者可致心源性猝死。LQTS按病因可分为获得性和遗传性两种类型。获得性LQTS通常与心肌局部缺血、心动过缓、电解质异常和应用某些药物有关；遗传性LQTS又有两种形式，包括Romano-Word（Rws）综合征和Jervell and lange-Nielsen（JLN）综合征。RWS综合征最常见，为常染色体显性遗传，后代患病的几率为50％。遗传性心律失常的恶性心律失常发生率高，药物治疗效果多不理想，常以反复晕厥、猝死为主要临床表现，植入型埋藏式心脏复律除颤器（Implanable Cardioverter Defib-rillator，ICD）是目前最有效、最可靠的治疗手段，可最大限度地挽救患者的生命[1]。循证医学实践证明，LQTS患者如抗肾上腺素能治疗（如8受体阻断剂）、左侧心交感神经切除术、药物治疗效果不理想且反复晕厥，则需要辅以起搏器或ICD治疗[2]。2013年7月本科收治1例13岁女童，为先天性LQTS，在应用β受体阻断剂倍他乐克控制心率后植入ICD进行治疗，现将护理体会报告如下。
