植入型心律转复除颤器导致误放电8例

目的探讨植入型心律转复除颤器(ICD)导致的误放电原因,为避免和减少误放电提供参考。方法分析8例患者共植入11台ICD的临床随访资料。8例患者7例为男性,1例女性,其中单腔ICD 7台,双腔ICD 3台,三腔植入型心律转复除颤器(CRT-D)1台。随访2～12年,平均7年。结果随访中除1例死亡外其余患者均存活。ICD共检出心律失常568次,启动治疗程序125次,其中误放电16次(12.8%),大部分发生在早年植入ICD的3例患者中。误放电原因包括:感知窦性心动过速3次,占误放电的18.8%,电磁干扰4次,占25%,电极导线绝缘层破损干扰9次,占56.3%。结论ICD误放电会给患者带来极大的身心伤害,应该受到重视。     

双腔植入型心律转复除颤器的临床应用——附一例报告

目的：观察植入型心律转复除颤器（ICD）植入术后的临床情况。方法：明确诊断为缺血性心肌病、病窦综合征、频发室性早搏,行ICD治疗。结果：术后随访3个月,无误放电发生,患者心功能良好。结论：双腔ICD由于增加了心房电极导线,可提高对房性心律失常的识别能力,从而减少误放电。对伴有房性心律失常及心动过缓的患者应使用双腔ICD。     

植入型自动心律转复除颤器的临床应用效果

目的研究植入型自动心律转复除颤器（ICD）在临床中的应用以及随访中发现的问题,并探求解决的方法.方法对我院6例植入ICD病人进行回顾性分析.结果 6例病人手术均成功,术中术后无并发症,随访显示病人有28次电击感,其中3次心房颤动误放电,余均为低能量转复.所有病人均应用抗心律失常药物治疗,1例药物治疗无效,采用射频消融术治疗成功.结论 ICD是恶性室性心律失常的首选治疗方法,可迅速高效地终止恶性室性心律失常;ICD植入方法较简单,手术成功率高,但术后应定期随访,及时调整参数,解决ICD工作中的问题,同时必须辅以必要的药物治疗.双腔ICD可减少误放电,依靠房室顺序起搏可改善充血性心力衰竭,对病人更有益.     

植入型心律转复除颤器除颤电极导线功能故障的原因及处理

目的 探讨植入型心律转复除颤器（ICD）及心脏再同步化心律转复除颤器（CRT-D）除颤电极导线功能故障的发生率、可能原因及处理方法.方法 对166例植入ICD或CRT-D的患者进行长期跟踪随访,统计除颤电极导线功能故障发生率,分析其可能原因及处理方法.结果 166例患者中出现除颤电极导线功能故障5例,发生率为3.01%.其中电极导线绝缘层破裂1例,ICD导线功能障碍1例,R波感知逐渐降低3例.其中2例予以更换除颤电极导线,2例予以植入普通主动固定电极导线,余1例随访中待择期处理.结论 植入ICD或CRT-D的患者,除颤电极导线功能障碍可引起ICD不适当放电,随访中若发现除颤电极导线功能障碍,应及时更换导线.     

植入型心律转复除颤器的临床应用

目的：总结应用植入型心律转复除颤器（ICD）治疗恶性室性心律失常的体会和短期随访结果。方法：8例因反复发作伴有血液动力学障碍的室性心律失常/心室颤动（VT／VF）患者，5例植入单腔ICD、2例植入双腔ICD，1例植入三腔ICD，并应用药物治疗，随访半年～6年。结果：8例患者无一例死亡，所有患者再发恶性室性心律失常时全部经ICD成功转复窦性心率，植入三腔ICD患者心功能较术前明显改善。结论：ICD治疗恶性室性心律失常效果肯定，三腔ICD除治疗恶性心律失常以外，还能改善心衰患者的心功能。     

植入型心律转复除颤器的临床应用及随访

目的报道埋藏式心脏转复除颤器(ICD)治疗恶性室性心律失常的疗效及随访结果。方法对置入ICD的5例患者进行电话询问和门诊随访,通过常规心电图、动态心电图及ICD存储的资料,对患者病情和ICD工作情况进行分析。结果5台ICD共检出心律失常事件238次,其中183次为短阵非持续性室性心动过速(VT),自行终止;55次为持续性室性心动过速/心室颤动(VT/VF),29次经抗心动过速(ATP)终止,18次经低能量电击终止,8次经高能量电击终止,再发恶性室性心律失常全部经ICD成功转复为窦性心率,有效率100%。误放电治疗8次,误放电原因:阵发性心房颤动心室率超过设置的VT频率,ICD发生误识别,经调整识别频率后,未再发生。结论ICD治疗恶性室性心律失常效果肯定,但应加强随访,警惕误放电。     

植入型心脏复律除颤器的临床应用

目的：总结植入型心脏复律除颤器（ICD）的植入过程随访结果。方法：3例ICD，其中2例为单腔ICD，1例为双腔ICD。3根起搏和除颤电极通过锁骨下静脉穿刺放置于右室心尖部，1根右心房主动固定电极置于右心房游离壁。2台单腔ICD埋藏于左侧胸大肌、胸小肌肌间隙内。1台双腔ICD埋藏于左侧胸大肌表面皮下。结果：测定植入导线起搏阈值，感知、R波振幅，P波振幅，阻抗等参数均符合ICD植入要求。DFT测定分别为5J、10J、15J，随访3－6个月，仅1例患3个月左右出现一过性囊袋血肿，经简单处理后好转，无起搏器其他并发症，ICD共检测到室速或室颤事件20次，其中12次自行终止，1次室速行快速起搏治疗成功，7次电击成功，误放电1次，双腔ICD电击1次，结论：ICD是治疗致命性快速型室性心律失常安全，有效的方法。     

植入型心律转复除颤器的临床应用

目的观察植入型心律转复除颤器（ICD）植入术后的治疗效果，分析影响ICD治疗效果的因素。方法回顾性分析2002年4月～2006年12月在兰州大学第一医院心内科住院的6例ICD植入患者的临床资料及随访资料。结果6例ICD植入患者手术成功，无手术并发症，随访6～73个月，无死亡病例。术后6例患者均长期口服抗心律失常药物。1例患者因窦性心动过速ICD出现误识别和误放电3次，开启突发性识别后，随访12个月再未发现误放电现象。2例因停用抗心律失常药物出现电风暴3次，经强化抗心律失常药物治疗和积极预防上呼吸道感染，随访6～12月再未出现电风暴。3例患者的室性心律失常发生有明确诱因，预防和治疗诱因可减少ICD治疗次数。结论ICD能有效治疗恶性室性心律失常，预防心源性猝死。术后加强随访、合理设置工作参数、配合药物治疗、积极预防诱因是保障ICD有效治疗的重要影响因素。     

植入型心律转复除颤器的临床随访及疗效评价

目的 观察评价植入型心律转复除颤器(ICD)植入后恶性室性心律失常的工作情况及疗效.方法 对恶性室性心律失常包括室性心动过速(室速)或心室颤动(室颤)接受ICD治疗者35例,应用体外程控仪调出ICD存储记录的资料共计49例次进行分析,总结随访资料以评价ICD治疗恶性室性心律失常的效果.结果 35例植入ICD的患者随访平均(33±19)个月,ICD记录室速596阵,抗心动过速(ATP)治疗成功478阵(成功率80.2%);高能量除颤(DF)终止25次室颤均获成功;5例误放电18次;4例术后出现心律失常电风暴;1例术后1月因顽固性心力衰竭死亡.结论 ICD能有效治疗恶性室性心律失常,可能发生误放电、心律失常电风暴及精神症状,植入后应定期随访,及时调整参数,联合应用抗心律失常药物,同时给予心理辅导治疗是必要的.     

埋藏式心脏复律除颤器临床应用

目的 观察5例恶性室性心律失常患者行埋藏式心脏复律除颤器（ICD）植入术及临床随访情况。方法 5例因反复发作室性心动过速／心室颤动（VT／VF）均顺利植入ICD（其中双腔ICD1例），随访1－22个月，观察患者临床疗效及ICD工作情况。结果 5例患者术后无一例死亡，再次出现VT／VF共52次，经ICD治疗成功转复为窦性心律。结论 ICD植入术成功率高，治疗恶性室性心律失常疗效确切，术后随访、及时调整ICD参数十分重要。     

Incidence and causes of inappropriate detection and therapy by implantable defibrillators of cardioversion in patients with ventricular tachyarrhythmia

Background Implantable cardioverter defibrillator （ICD） is the only effective therapy in patients with life threatening ventricular arrhythmias. Inappropriate detection and therapy by ICDs are the most common causes of side effects that affect the quality of life in ICD recipients. This study evaluated the incidence and causes of inappropriate detection and therapy by ICDs in patients in our hospital. Methods From January 2000 to December 2005, fifty patients who received ICD implantation for ventricular arrhythmias for prevention of sudden cardiac death were evaluated in this study. Each ICD was programmed using clinical arrhythmic and cardiac data of the patient before discharge. Patients were followed up by standard schedule after implantation and all data retrieved from each device were collected and saved for further analysis. Results No arrhythmic event was detected in 12/50 （24%） patients during the period of follow-up. Among the remaining patients, 11 （22%） experienced inappropriate detections and therapies during follow-up in this study. ICD detected 383 ventricular tachyarrhythmia （VT） and 108 ventricular fibrillation （VF） episodes and delivered 678 therapies. In VT group, ICD delivered 413 antitachycardiac pacings （ATPs） and 118 shocks, among which 78 ATPs and 9 shocks were initiated by 55/383 （14.3%） inappropriate detections. In VF group ICD delivered 147 shocks, among which 56 shocks were initiated by 28/108 （26.9%） inappropriate detections. Overall, more than 50% of these episodes were caused by atrial fibrillation （AF） with rapid ventricular response, followed by electromagnetic or myopotential interference. In addition, most inappropriate therapies occurred within one year after ICD implantation. Conclusions About one fifth of patients experienced ICD inappropriate detection and therapy after implantation. The main cause was AF with rapid ventricular response, followed by electromagnetic or myopotential interference.     

植入心律转复除颤器患者室性心律失常和放电事件的相关分析

【目的】 分析植入心律转复除颤器(ICD)患者在一级或二级预防中发生室性心律失常和放电治疗情况及相关因素。 【方法】 对2004年3月至2012年9月在中山大学附属第一医院植入了ICD的92例患者进行程控随访,结合患者的临床资料进行回顾性分析。【结果】 92例患者,其中ICD一级预防45例,二级预防47例,共进行了423人次的程控随访,平均随访时间(27.6 ± 21.8)个月。有37.8%的一级预防患者出现了室速/室颤(VT/VF),平均2.53次/人年;28.9%的患者给予了放电治疗,平均0.44次/人年。在二级预防中有59.6%的患者出现VT/VF,平均4.99次/人年,其中有47.9%需要放电治疗,平均为1.41次/人年。所有患者中,有46例ICD发生放电(50.0%),其中恰当放电的35例(38.0%),不恰当放电的11例(12.0%)。总计放电334次,其中恰当的放电治疗198次(59.3%),不恰当的放电治疗136次(40.7%)。不恰当放电原因包括:房颤92次(67.6%),阵发性室上性心动过速32次(23.5%),ICD异常感知12次(8.8%)。有房颤病史的患者发生VT/VF的概率以及误放电的概率均高于无房颤病史的患者,差异有统计学意义(P < 0.05)。【结论】 ICD在心脏性猝死的一级预防能给患者带来获益;房颤既是ICD不恰当放电的主要原因,也是提示VT/VF高发的指标。     

Primary prevention of sudden cardiac death by implantable cardioverter-defibrillator therapy in Chinese patients with heart failure: a single-center experience

Background An implantable cardioverter-defibrillator （ICD） has been suggested for heart failure patients for primary prevention of sudden cardiac death. However, few data have been reported on the application of ICD as primary prevention of sudden cardiac death in China. We evaluated the value of primary prevention ICD therapy in Chinese patients with heart failure.Methods Thirty-four patients at an average age of （60.2±13.7） years seen in Peking Union Medical College Hospital were treated with ICD implantation for primary prevention of sudden cardiac death from November 2005 to July 2009. Single-chamber ICDs were implanted in 16 （47.0%） cases, and dual-chamber or cardiac resynchronization therapy defibrillators in 18 （53.0%） cases. The patients had an average left ventricular ejection fraction of （26.9±5.5）% （11% to 35%）, of which 18 （53.0%） patients had ischemic cardiomyopathy and 16 （47.0%） patients had non-ischemic cardiomyopathy. All patients were followed up at three months after the implantation and every six months thereafter or when prompted by an ICD event.Results There were five （14.7%） deaths, including two of heart failure and three with a non-cardiac course, during an average follow-up of （15.0±11.9） months. Forty-one ICD therapy events were recorded, including 19 （46.3%） appropriate ICD therapies in six patients and 22 （53.7%） inappropriate ICD therapies in four patients with single chamber leads. Inappropriate ICD therapies were mainly due to supraventricular tachyarrhythmias, especially atrial fibrillation. Patients with ischemic cardiomyopathy and non-ischemic cardiomyopathy did not differ in the incidence of either appropriate or inappropriate therapy.Conclusions ICD for primary prevention of sudden cardiac death in China prevents patients from arrhythmia death. Relatively high incidence of inappropriate therapies highlights the importance of an atrial lead.     

植入型心律转复除颤器的术后程控

植入型心律转复除颤器（ICD）作为心脏性猝死（SCD）的有效预防措施,在临床中逐渐得到广泛应用。通过设置一系列参数,ICD可正确识别和治疗快速性室性心律失常。与此同时,ICD针对非快速性室性心律失常及可自行终止的室速等发放的不适当和不必要放电会降低患者的临床获益,甚至增加死亡风险。因此,ICD术后需要进行长期随访并根据实际情况进行参数程控。本文就如何合理设置ICD参数以减少不适当和不必要放电进行综述。     

Clinical characteristics and treatment outcomes of patients with Brugada syndrome in northeastern Thailand

INTRODUCTION

Brugada syndrome (BrS) is a common genetic cause of sudden cardiac arrest (SCA) due to polymorphic ventricular tachycardia and ventricular fibrillation. The current recommended therapy for high-risk BrS patients is the use of an implantable cardioverter defibrillator (ICD). The present study aimed to report the clinical characteristics and treatment outcomes of BrS patients in northeastern Thailand.

METHODS

Patients who were diagnosed with BrS or had a Brugada electrocardiogram (ECG) between 2005 and 2012 at Khon Kaen University’s hospitals were enrolled in the present study. Patients’ clinical characteristics, ECG type, laboratory results and treatment were reviewed.

RESULTS

A total of 90 eligible patients were enrolled. Of these, 79 (87.8%) patients were symptomatic – 65 (82.3%) had documented SCA and 14 (17.7%) had unexplained syncope. The remaining 11 (12.2%) patients were asymptomatic with Brugada ECG. A majority of the patients enrolled were born in northeastern Thailand. The mean age of the symptomatic patients was 44.49 ± 8.55 years. Among the symptomatic patients, a majority were male (n = 77, 97.5%) and 23 (29.1%) patients had a family history of SCA. Almost all BrS patients who were symptomatic (96.2%) received ICD treatment for secondary prevention. The number of patients who received appropriate ICD therapy was 4.2 times of those who received inappropriate shocks. Only 3 (3.8%) symptomatic BrS patients refused ICD treatment.

CONCLUSION

Clinical characteristics did not distinguish between symptomatic BrS patients and asymptomatic patients with Brugada ECGs. The clinical characteristics and treatment outcomes for the symptomatic BrS patients with SCA and unexplained syncope were similar. Among the BrS patients implanted with secondary prevention ICD in Northeastern Thailand, nearly one-third had received appropriate ICD therapy, far exceeding the incidence of device-related complications and inappropriate therapy.     

心律转复除颤器植入术中避免常规 除颤阈值测试的随访观察

目的：探讨心律转复除颤器（ICD）和心室再同步心脏转复除颤器（CRT-D）植入术中未进行除颤阈值测试的患者,治疗恶性室性心律失常的有效性和安全性。方法：收集1999年10月至2008年8月间ICD植入术中未进行除颤阈值测试的21例ICD/CRT-D患者临床资料,应用体外程控仪获取存取信息并结合随访资料进行分析。结果：17例室性心动过速（室速）或心室颤动（室颤）患者植入ICD,4例心肌病合并严重心力衰竭患者植入CRT-D,术中均未进行除颤阈值测试。8例术后1周进行除颤阈值测试,其中3例（37.5%）未诱发出室速/室颤。程控随访1~7(4.2±1.9)年,21例未进行除颤阈值测试的患者中16例记录到室速或室颤事件,ICD成功除颤89阵（成功率100%）,抗心动过速起搏（ATP）终止室速120阵次（成功率51.1%）,低能量同步转复22阵次（成功率59.2%）。术后大多数患者联合应用抗心律失常药物,无恶性室性心律失常相关死亡病例。结论：ICD/CRT-D植入术中不常规进行除颤阈值测试可避免相关并发症发生,术后随访可有效治疗恶性室性心律失常,预防心脏性猝死。     

埋藏式心脏复律除颤器在心脏性猝死一级预防中的作用

目的探讨埋藏式心脏复律除颤器（ICD）在心脏性猝死（SCD）一级预防中的作用。方法对35 例在2006~2009 年根据
2005年ACC/AHC指南植入ICD进行SCD一级预防的患者,进行平均2年的临床随访数据分析。结果（1）平均2年随访过程
中,共11例患者（31.43%）发生室性心律失常事件,室颤除颤16阵次、室速启动抗心动过速起搏（ATP）79阵次,无误放电,无一例
死亡;（2）室性心律失常事件,心肌致密化不全（NVM）发生率为100%、特发性室性心动过速（PVT）66.67%、Brugada 综合征
50%、肥厚型心肌病（HCM）25%和（DCM）16.67%;其中室颤PVT占87.5%（14 阵次）,DCM及Brugada 综合征各1 阵次;室速
PVT占82.28%（65阵次）、NVM 5阵次、HCM和Brugada综合征各4阵次和DCM患者1阵次,致心律失常右室心肌病未见室性
心律失常事件;（3）术中术后未见植入ICD相关并发症,术后均未出现恶性室性心律失常所致晕厥,生活质量明显改善。结论本
组SCD高危患者中,平均ICD 植入两年即在31.43%的患者中及时发现和纠正95 次的恶性室性心率失常事件,其中对预防
PVT、NVM和Brugada综合征的SCD最为明显,提示SCD高危人群中植入ICD进行一级预防有重要的临床价值。
     

Clinical study of 39 Chinese patients with arrhythmogenic right ventricular dysplasia/cardiomyopathy

Background There are few studies on the clinical profile of Chinese patients with arrhythmogenic right ventricular dysplasia/cardiomyopathy （ARVD/C）. The purpose of this study was to describe the clinical characteristics of ARVD/C patients from China, particularly to define the features of electrocardiograph and treatment outcomes.
Methods Thirty-nine patients hospitalized in Fu Wai Cardiovascular Hospital from 1998 to 2006 were included. The data were obtained from the medical archive and the follow-up records.
Results Of these patients 33 were male and 6 female （age at the first presentation was （34.9 ± 9.8） years）. The most common symptoms were palpitation （62%） and syncope （44%）. Right precordial QRSd 〉 110 ms was detected in 69% of the patients, epsilon wave in 59%, and a ratio of QRSd in V1＋V2＋V3/V4＋V5＋V6 ≥ 1.2 in 82%. The most frequent features of electrocardiogram in patients without right bundle-branch block were T-wave inversions and S-wave upstroke in V1-V3 〉55 ms （96% and 90% of 28 patients, respectively）. Radiofrequency catheter ablation （RFCA） for ventricular tachycardia （VT） was successful in 15 （68%） of 22 patients. The recurrence rate of VT was 46% （7/15） during the follow-up of （16.7 ± 11.2） months. Seven patients had cardioverter/defibrillator （ICD） implanted plus drug therapy and 17 patients took antiarrhythmic drugs alone. During the follow-up of （35.6 ± 19.0） months, all patients with ICD implanted received at least one appropriate ICD shock. One patient died of ventricular fibrillation suddenly and one patient underwent heart transplantation for progressive biventricular heart failure during the drug therapy alone.
Conclusions This study demonstrated the clinical and ECG features of the 39 ARVD/C Chinese patients. ICD provided life-saving protection by effectively terminating malignant arrhythmias, and the high recurrence of VT was the major problem of RFCA therapy.     

Experience on application of transveneous implantable MINI Ⅱ cardioverterdefibrillator for ventricular tachycardia due to right ventricular dysplasia:a report of a case

Theimplantablecardioverterdefibrillator(ICD)therapyhasbecomeanimportantmethodfortreatingmalignantventrlculartachyarrhythmiasatpresent.ThisreportdealswithourPrimaryexperienceinclinicalapplicationoftransveneousimplantablecardioverterdeflbrlllator.CLINICALMATERIALSA43--year--oldmalepatientadmittedtohospitalonoctober10.1997becauseofparoxymalventrlculartachycardla(VT).HecomplainedofsufferingVTasmanyas6timesduring2years.TherateofVTwas110to180bpm.In:3times.V'YcouldnotbeterminatedbyInject…