具有埋藏式心脏转复除颤器植入适应证患者的调查与随访

目的调查符合植入埋藏式心脏转复除颤器(ICD)适应证患者的基础病因、临床特征、治疗选择及预后。方法入选本院符合ICD适应证的152例患者,收集其基本资料及相关病史,记录入院期间检查结果及治疗情况,并对死亡率和恶性室性心律失常发生率进行随访。结果符合ICD适应证患者以缺血性心脏病最多;ICD心脏性猝死一级预防适应证患者明显多于二级预防适应证患者(118 vs 34);二级预防适应证患者植入ICD的比例明显多于一级预防适应证患者44.1%(15/34)vs 9.3%(11/118)];随访结束发现植入ICD/CRT-D患者的全因死亡率要明显低于未植入ICD/CRT-D患者0%vs 17.5%(20/114)](P<0.05)。结论 ICD/CRT-D能减低ICD适应证患者的全因死亡率,然而临床上ICD作为心脏性猝死预防的实际应用要远远低于其指征范围。

Investigation and follow-up of the patients with implantable cardioverter defibrillator indications.

Objective To investigate the composition of patients with implantable cardioverter defibrillator （ICD） indi- cations, the application of ICD in the primary and second prevention for sudden cardiac disease （SCD） and the difference of outcome between patients with ICD implantation and patients without ICD implantation. Method One hundred and fifty-two patients who had ICD indications were enrolled. Their basic information and related medical history were collected, and the examination results and treatment state were recorded. Then, through the telephone and out-patient follow-up, we got the information of vicious incidents or death of the patients, and also the working conditions of the ICDs. Results In patients with ICD indication, chronic heart failure caused by isehemic heart disease was the most common cause. The population of primary prevention patients was bigger than that of secondary prevention patients（ 118 vs 34 ）. The rate of ICD implantation was lower in the primary prevention patients than the secondary prevention patients 44.1% （ 15/34 ） 9.3 % （ 11/ 118 ） ]. All-cause mortality of patients with ICD implantation was lower than that of patients without ICD implantation（0% vs 17.5% ,P 〈 0.05 ）. Conclusions All-canse mortality can be reduced by ICD implantation. However, the clinical applications of ICD as the prevention for SCD are far below its indication rate, especial as the primary prevention.