埋藏式心律转复除颤器治疗恶性室性心律失常的临床应用评价

埋藏式心律转复除颤器治疗恶性室性心律失常的临床应用评价华伟综述王方正审校１概述心源性猝死是现代医学面临的一个重要问题，以美国为例，每年要夺去３０～５０万患者的生命。心源性猝死的主要原因经心电图监测技术证实，医院外的心脏停搏者多数是由心室颤动（简称室颤...     

埋藏型心律转复除颤器

埋藏型心律转复除颤器宋业年（蚌埠医学院附属医院心内科２３３００４）关键词心律失常心律转复除颤器１引言ＭｉｃｈａｌＭｉｒｏｗｓｋｉ医生１９８５年首次报道为治疗恶性室性心律失常而研究设计的一种器械，并称之谓埋藏型心律转复除颤器(ａｕｔｏｍａｔｉｃｉｍｐｌ...     

植入型心律转复除颤器治疗快速心律失常

１９８０年２月，Ｍｉｒｏｗｓｋ首次为一位心脏骤停幸存者应用植入型心律转复除颤器（ＩＣＤ）的最早产品ＡＩＤ（植入型自动除颤器，ａｕｔｏｍａｔｉｃｉｍｐｌａｎｔａｂｌｅｄｅｆｉｂｒｉｌａｔｏｒ）治疗取得成功。１９年来，ＩＣＤ的设计不断完善，功能日益复杂精...     

埋藏式心律转复除颤器的置入及随访

埋藏式心律转复除颤器 (ICD)技术发展非常迅速 ,自 1980年该技术首次成功应用于人类至目前 ,已出现第四代产品。新型 ICD具有心脏起搏 (VVI型 )、抗心动过速起搏 ,除颤 (室颤 ) ,心电记录等多种功能。现把我院成功安装 1例 ICD(Medtronic772 0 C型 )及随访情况报道如下。1　临床资料男患 ,6 7岁 ,干部。因间断性心悸 2 5年 ,加重 1个月于1999年 2月入院。 2 5年前曾于我院通过心电及心向量图诊断为急性前间壁心肌梗死。经复方丹参等药物治疗 ,症状好转出院。以后每年均有 1～ 2次心悸等症状发作 ,每次均持续数分钟缓解 ,未予治疗 ,1…     

植入型心律转复除颤器在心律失常治疗中的应用

自1996年1月以来,我们对7例心律失常患者于治疗过程中采用植入型心律转复除颠器（ICD）,获得满意疗效。现报告如下。     

经静脉心律转复除颤器的临床应用

目的　评价经静脉心律转复除颤器 (ICD)对恶性室性心律失常的治疗作用。方法　 6例药物难治性反复发作的室性心动过速 (VT)及 /或心室颤动 (VF)患者接受经静脉ICD治疗 ,并随访 12±7 0月 (1～ 2 1月 )。其中冠心病 2例 ,扩张型心肌病 1例 ,原发性室颤 3例。结果　 6例成功地置入经静脉ICD ,脉冲发生器埋于左上胸皮下 5例 ,胸大肌与胸小肌之间 1例。 3例经ICD储存资料证实共发生VT45 1次 ,均被ICD有效终止。 3例患者共有 6次VT经电击复律成功。 2例分别因窦性心动过速和心房颤动而误放电 ,其中 1例因口服胺碘酮致VT频率减慢至VT探查窗口以下而未被ICD察觉 ,经程控调整有关设置后得以纠正。结论　经静脉ICD是一种植入方法简单、能有效终止恶性室性心律失常和减少心律失常性死亡的重要手段。定期随访和针对患者改变的心律失常状况的再程控 ,是防止误放电和保证ICD有效工作的重要措施     

心脏性猝死的预防及我国埋藏式心律转复除颤器应用状况

目的通过对全国部分医院的回顾性调查研究,了解我国埋藏式心律转复除颤器(ICD)使用状况.方法回顾性分析了1996年1月18日到2003年1月31日,来自82家医院的173例ICD患者的临床情况,了解其基础病因、心律失常类型、ICD对心律失常的治疗情况以及ICD的并发症.结果 173例植入ICD患者,其中115例(66.5%)有各种器质性心脏病,以冠心病为最常见.植入患者中室性心动过速(VT) 106例(61.3%),心室颤动(VF) 34例(19.6%),VT合并VF 33例(19.1%).在平均随访27.8个月(1～86个月)中,82例 (47.4%)发生VT和/或VF,并接受ICD成功治疗;73.04%的VT通过抗心动过速起搏(ATP)终止;VF除颤成功率为100%;误放电率为2.0%.术后并发症发生率为2.3%,随访期间共有11例患者死亡,占6.4%.结论本研究的有限数据表明ICD治疗对我国患者带来的好处,但其应用尚处于起步阶段.     

埋藏式心律转复除颤器患者健康教育与出院后随访

致命性室性心律失常(持续性室性心动过速,心室扑动和心室颤动)是心脏性猝死的主要原因.植入型心律转复除颤器(ICD)已广泛用于治疗致命性室性心律失常和心源性猝死的高危患者.临床资料表明,ICD能降低致命性室常急性期病死率,疗效明显优于抗心律失常药[1].     

植入型心律转复除颤器的临床应用

自从１９８０年问世以来,植入型心律转复除颤器（ＩＣＤ）已成为临床上治疗持续性或致命性室性心律失常的一个重要手段。ＩＣＤ的概念最早出现于６０年代,但对于其应用价值一直存在争议,直到１９８０年,Ｍｉｒｏｗｓｋｉ首先将其应用于人体,其有效性及临床应用价值才开始被承认。１９８５年,美国食品与药物管理局（ＦＤＡ）批准了ＣＰＩ公司的第一代ＩＣＤ（植入型心脏自动除颤器,ＡＩＣＤ）用于临床,自那时以来,ＩＣＤ的制造技术取得了较大突破,无论是在设计、功能及可靠性等方面均有了很大的改善。ＡＩＣＤ除了体积庞大、使用寿…     

Long-term intravenous infusion of antiarrhythmic drugs using a totally implanted drug delivery system

In vitro and in vivo testing was performed to establish the feasibility of a totally implantable pump system to deliver antiarrhythmic agents. In vitro flow characteristics suggested predictable day to day delivery with acceptably small variations in flow with changes in reservoir volume or temperature. During 3 months of in vitro testing, procainamide and bretylium were found suitable for long-term delivery. Delivery of lidocaine was limited by high viscosity and corrosion of steel elements within the pump. The pump was implanted in a subcutaneous pocket in four dogs. Procainamide (0.5 g/ml), delivered at 4 ml/day (70 mg/kg body weight per day), provided a mean steady state drug concentration of 5.3 μg/ml. Bretylium (50 mg/ml), delivered at 8 ml/day (13 mg/kg per day), provided a steady state concentration of 0.8 μg/ml (range 0.4 to 1.4). Long-term intravenous administration of therapeutic doses of bretylium and procainamide with this delivery system has been demonstrated in dogs and appears to be feasible in human subjects.     

植入型心律转复除颤器抗心动过速起搏治疗室性心动过速疗效评价

目的恶性室性心律失常（室性心动过速,心室颤动）是心脏性猝死的主要直接原因.而大部分患者先发生室性心动过速（室速）,继而蜕变为心室颤动（室颤）.研究表明,抗心动过速起搏（ATP）可有效终止室速.本文观察了172例植人植入型心律转复除颤器（ICD）的患者应用ATP终止室速的效果.方法172例植入ICD的患者,男性137例,女性35例,平均年龄52.8岁.103例患者术前有阿-斯综合征发作史,其中75例有电击除颤史.137例术前记录到室速或室颤心电图.植入ICD患者定期随访,随访时应用体外程控仪调出ICD储存记录,分析ICD治疗中ATP治疗室速的效果.结果在平均随访37个月中,ICD共记录室速l 789阵.其中,316阵为短阵室速,在ICD治疗前自行终止;1 473阵室速接受了ICD有效治疗.其中ATP治疗成功981阵（成功率66.6%）,余492阵室速由低能量转复终止.在981阵ATP治疗成功的事件中,ICD第一次发放ATP成功终止室速513阵（成功率52.3%）.结论ICD抗室速起搏功能可有效终止大多数室速,对于植入ICD前有明确室速史的患者,ICD治疗应尽量先采用ATP治疗,以减少ICD放电,延长ICD使用寿命及避免电击时的痛苦,即所谓的＂无痛性ICD治疗＂.     

Hyponatremia in patients treated with lorcainide, a new antiarrhythmic drug

The effects of lorcainide, a new antiarrhythmic drug, on serum electrolytes and osmolality are described in a series of 33 patients with organic heart disease and complex ventricular arrhythmias treated with lorcainide. In eight patients, a mean decrease in serum Na+ of 8.25 +/- 3.2 mEq/L was observed after a single 200 mg intravenous dose of lorcainide. Sixteen of 33 patients developed significant hyponatremia and hypoosmolality during oral treatment with lorcainide. In all except two patients, serum Na+ returned to normal values within 3 to 12 months of continued lorcainide therapy. Low serum Na+ and hypoosmolality in the absence of volume depletion, clinically manifest edema, and unaltered renal, adrenal, cardiac, or thyroid function suggest that this antiarrhythmic drug produced the syndrome of inappropriate antidiuretic hormone secretion (SIADH). SIADH appeared to be transient and asymptomatic in our patients. One patient developed severe hyponatremia with serum Na+ of 108 mEq/L when hydrochlorothiazide was given to control hypertension. It is concluded that SIADH is an important side effect of lorcainide therapy. We recommend that serum Na+ be carefully monitored in patients started on lorcainide therapy, and extreme caution should be exercised in prescribing diuretics to patients with persistent hyponatremia.     

致心律失常性右心室心肌病植入心律转复除颤器治疗一例

患者女性,30岁,以"心悸6年,加重伴间断晕厥半月"入院.近6年活动后心悸,近2年双下肢和颜面间断水肿,半月来症状加重,并出现晕厥,在当地医院血压未测出,心电图证实为持续性室性心动过速(室速),静脉推注胺碘酮150 mg后转为窦性心律,意识恢复,转入我院.     

无痛治疗在植入型心律转复除颤器患者心脏性猝死一级和二级预防中的应用

目的 随访植入型心律转复除颤器(ICD)患者,了解抗心动过速起搏(antitachycardia pacing,ATP)作为室性心动过速(VT)无痛治疗手段在心脏性猝死一级和二级预防中的应用.方法 对2005年1月至2009年6月符合ICD一级和二级预防标准并在我院植入ICD的患者进行随访.将ICD的诊断程序设置为VT...     

Serial electrophysiological testing of antiarrhythmic drug efficacy in patients with recurrent ventricular tachycardia

The purpose of the present study was to determine the predictivevalue of serial electrophysiological testing during antiarrhythmictherapy in patients with recurrent ventricular tachycardia and/orventricular fibrillation in regard to symptomatic status andoutcome. Eleven patients (ten male, one female, mean age 54 ±10 years, mean ± S.D.J with recurrent ventricular tachycardiawere studied. Mean ejection fraction was 34 ± 12%. Mostpatients suffered from coronary artery disease. The median durationof recurrent ventricular tachycardia before the study was 12weeks (minimum one week, maximum 16 years). In seven patientsbetween one and 61 cardioversions had been performed beforethe study to terminate ventricular tachycardia. Ventricular tachycardia could be initiated by programmed rightventricular stimulation in all patients. After control recordingshad been obtained, the stimulation tests were repeated duringantiarrhythmic therapy until an effective regimen was found.The following drugs were used in this sequence: disopyramide,mexiletine, propafenone, aprindine plus beta-adrenergic blockingdrugs and digitalis. In three patients, there was no change in the inducibility ofventricular tachycardia during therapy whereas in eight patients,ventricular tachycardia was more difficult to induce or no longerinducible. Patients were followed at regular intervals (meanfollow-up time 41 ± 22 weeks). In those three patientsin whom ventricular tachycardia was still inducible, two suddendeaths occurred; one patient was referred to surgery becauseof persistent spontaneous and inducible attacks of ventriculartachycardia despite antiarrhythmic therapy. No cardiac deathoccurred in the eight patients in whom ventricular tachycardiawas more difficult to induce or no longer inducible. All patientswere asymptomatic, and had no recurrence of their ventriculartachycardia in their Hotter ECGs. Thus far, serial electrophysiological testing has been usefulin predicting antiarrhythmic drug efficacy in patients withrecurrent ventricular tachycardia. It may help to prevent suddendeath in these highly endangered patients.