埋藏式心脏复律除颤器治疗快速室性心律失常随访观察(摘要)
作者：华伟 王方正 陈新
单位：北京市，中国医学科学院 中国协和医科大学 心血管病研究所 阜外心血管病医院 临床电生理研究室(100037)
关键词：
目的 目的：对26例置入埋藏式心律转复除颤器(ICD)患者进行随访，观察ICD治疗快速室性心律失常的效果。
方法：26例恶性室性心律失常患者，男23例，女3例，平均年龄48.08岁，均置入了非开胸埋藏式心律转复除颤器系统。患者基础心脏病为扩张型心肌病11例，肥厚型心肌病2例，冠心病8例。QT延长综合征1例，其余4例未发现有器质性心脏病。所有患者均有院外晕厥史，均经临床证实有室性心动过速或心室颤动发作。除颤器为具有多项治疗功能及信息储存记忆功能的第3代ICD。其储存记忆功能可记录患者发作室性心动过速的次数及每次发作的时间，以及治疗情况，并可记录ICD治疗前后室性心动过速或心室颤动的心内电图，随访时通过体外程控仪调出ICD储存的资料进行分析。所有患者均进行了随访。
, 百拇医药
结果：在平均随访9.4个月(2～26个月)中，26例患者中有13例(50%)接受了ICD治疗。从ICD储存的资料显示，共有187次室性心动过速或心室颤动发作，其中54次为非持续性室性心动过速，自行终止。另外133次VT/VF发作接受了ICD治疗。在发作中，110次为室性心动过速。42次由ICD的抗心动过速起搏(ATP)终止，61次由低能量(2～15 J)转复终止，2次发作为窦性心动过速。其余5次室性心动过速，在ATP治疗过程中加速转为心室颤动，由高能量除颤终止。ICD认定的心室颤动发作共有23次，发生于5例患者，其中1例患者接受除颤16次，通过储存的心内电图分析，此例患者4次为室性心动过速，其频率超过心室颤动感知频率而被ICD认定为心室颤动。所有23次发作均被ICD有效除颤终止。在随访中，有2例患者死亡，2例均为扩张型心肌病患者，1例术后3个月死于心功能衰竭，另1例术后两个月曾反复发作心室颤动，多次接受ICD除颤，最后死于心力衰竭。
结论：埋藏式心律转复除颤器可有效地终止快速室性心律失常，常规进行随访及设定ICD合适的诊断和治疗参数，对提高治疗效果至关重要。
, 百拇医药
Clinical Follow-up of Patients with Implantable Cardioverter-Defibrillators (Abstract)
Department of Clinical Electrophysiology, Cardiovascular Institute and Fu Wai Hospital, CAMS and PUMC, Beijing (100037)
Hua Wei, Wang Fangzheng, Chen Xin.
Objective: To observe the efficacy of implantable cardioverter-defibrillator to treat ventricular tachyarrhythmias.
Methods: Twenty-six patients, 23 males and 3 females, mean age of 48.08 years were implanted nonthoracotomy ICD systems. The indications for implantation were VF in 18 patients and refractory VT in 8. All patients had syncope out of hospital. The device is the third generation ICD with multitherapies including antitachycardia pacing (ATP), cardiovertion and defibrillation and data storing functions. All patients were followed up at least once after ICD implantation.
, 百拇医药
Results: In the follow-up of 9.4 (2～26) months, 13 out of 26 patients (50%) received ICD therapy. The data stored in ICD showed that totally 187 episodes were detected by the devices. 54 of them were nonsustained VT which spontaneously terminated. 133 VT/VF episodes were treated by ICD. 110 of them were VT, 42 were terminated by ATP and 61 by low energy cardiovertion. 2 episodes were sinus tachycardia. Another 5 VT were accelerated to VF and terminated by high energy shocks. There were 23 VF episodes diagnosed by the devices, however 4 of them were confirmed VT with rate over VF detection criterion by reviewing the stored electrocardiogram. All the episodes were terminated by shocks. 2 patients died of heart failure during the follow-up.
Conclusion: The third generation ICD with multitherapy function has high efficacy in the termination of ventricular tachyarrhythmias. It is important to follow-up the patients and set appropriate parameters for diagnosis and therapy by ICD., 百拇医药
单位：北京市，中国医学科学院 中国协和医科大学 心血管病研究所 阜外心血管病医院 临床电生理研究室(100037)
关键词：
目的 目的：对26例置入埋藏式心律转复除颤器(ICD)患者进行随访，观察ICD治疗快速室性心律失常的效果。
方法：26例恶性室性心律失常患者，男23例，女3例，平均年龄48.08岁，均置入了非开胸埋藏式心律转复除颤器系统。患者基础心脏病为扩张型心肌病11例，肥厚型心肌病2例，冠心病8例。QT延长综合征1例，其余4例未发现有器质性心脏病。所有患者均有院外晕厥史，均经临床证实有室性心动过速或心室颤动发作。除颤器为具有多项治疗功能及信息储存记忆功能的第3代ICD。其储存记忆功能可记录患者发作室性心动过速的次数及每次发作的时间，以及治疗情况，并可记录ICD治疗前后室性心动过速或心室颤动的心内电图，随访时通过体外程控仪调出ICD储存的资料进行分析。所有患者均进行了随访。
, 百拇医药
结果：在平均随访9.4个月(2～26个月)中，26例患者中有13例(50%)接受了ICD治疗。从ICD储存的资料显示，共有187次室性心动过速或心室颤动发作，其中54次为非持续性室性心动过速，自行终止。另外133次VT/VF发作接受了ICD治疗。在发作中，110次为室性心动过速。42次由ICD的抗心动过速起搏(ATP)终止，61次由低能量(2～15 J)转复终止，2次发作为窦性心动过速。其余5次室性心动过速，在ATP治疗过程中加速转为心室颤动，由高能量除颤终止。ICD认定的心室颤动发作共有23次，发生于5例患者，其中1例患者接受除颤16次，通过储存的心内电图分析，此例患者4次为室性心动过速，其频率超过心室颤动感知频率而被ICD认定为心室颤动。所有23次发作均被ICD有效除颤终止。在随访中，有2例患者死亡，2例均为扩张型心肌病患者，1例术后3个月死于心功能衰竭，另1例术后两个月曾反复发作心室颤动，多次接受ICD除颤，最后死于心力衰竭。
结论：埋藏式心律转复除颤器可有效地终止快速室性心律失常，常规进行随访及设定ICD合适的诊断和治疗参数，对提高治疗效果至关重要。
, 百拇医药
Clinical Follow-up of Patients with Implantable Cardioverter-Defibrillators (Abstract)
Department of Clinical Electrophysiology, Cardiovascular Institute and Fu Wai Hospital, CAMS and PUMC, Beijing (100037)
Hua Wei, Wang Fangzheng, Chen Xin.
Objective: To observe the efficacy of implantable cardioverter-defibrillator to treat ventricular tachyarrhythmias.
Methods: Twenty-six patients, 23 males and 3 females, mean age of 48.08 years were implanted nonthoracotomy ICD systems. The indications for implantation were VF in 18 patients and refractory VT in 8. All patients had syncope out of hospital. The device is the third generation ICD with multitherapies including antitachycardia pacing (ATP), cardiovertion and defibrillation and data storing functions. All patients were followed up at least once after ICD implantation.
, 百拇医药
Results: In the follow-up of 9.4 (2～26) months, 13 out of 26 patients (50%) received ICD therapy. The data stored in ICD showed that totally 187 episodes were detected by the devices. 54 of them were nonsustained VT which spontaneously terminated. 133 VT/VF episodes were treated by ICD. 110 of them were VT, 42 were terminated by ATP and 61 by low energy cardiovertion. 2 episodes were sinus tachycardia. Another 5 VT were accelerated to VF and terminated by high energy shocks. There were 23 VF episodes diagnosed by the devices, however 4 of them were confirmed VT with rate over VF detection criterion by reviewing the stored electrocardiogram. All the episodes were terminated by shocks. 2 patients died of heart failure during the follow-up.
Conclusion: The third generation ICD with multitherapy function has high efficacy in the termination of ventricular tachyarrhythmias. It is important to follow-up the patients and set appropriate parameters for diagnosis and therapy by ICD., 百拇医药