埋藏式心内除颤器应用4例报告

对４名器质性心脏病继发顽固、重症室性心动过速和／或心室纤颤（ＶＴ／Ｖｆ）患者采用埋藏式心内除颤器治疗,得左锁骨下静脉穿刺。将ＩＣＤ心内三级导管引入右室心尖部。将ＩＣＤ埋入左上胸囊袋,借助程控电脑诱发ＶＴ／Ｖｆ,确认ＩＣＤ确能有效感知和终上ＶＴ／Ｖｆ后缝合切口。结果：４例患者平均随访７月,均未再发晕厥,共发生ＶＴ１９次。均被ＩＣＤ在１１ｓ内成功终止,未发生与ＩＣＤ相关的并发症,结果表明：ＩＣＤ的疗效     

ICD应用临床分析

目的报告50例植入型心律转复除颤器(ICD)的临床应用观察.方法对我院1998年5月至2005年11月植入的45例,另有5例更换ICD的患者的临床应用进行观察(3~90个月).结果7例患者死亡,其余43例发生千次以上严重心律失常均由ICD成功终止.结论ICD手术过程安全,术后要密切随访,及时调整工作参数,即可达到较好防治严重心律失常降低猝死的疗效.     

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。     

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。     

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.     

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…     

三腔ICD临床应用5例报告

目的三腔ICD治疗5例心衰同时合并室性心动过速结果分析.方法应用三腔ICD治疗5例心衰同时合并室性心动过速(简称室速)患者,4例为原发性扩张型心脏病,1例为冠心病,2例有昏厥史.4例植入INSYNC 7272埋藏式心脏转复除颤器(ICD),1例植入V-350 ICD.结果随访时间1~14月,心功能得到改善,未发生室速,均未发生昏厥.5例中1例出现室性心动过速和心室颤动发作(简称室颤)均被ICD识别并进行放电除颤治疗,挽救了患者的生命.结论三腔ICD是治疗猝死、致死性心律失常和心衰的有效措施.     

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。     

Clinical use of nonthoracotomy cardioversion-defibrillation system

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Tp-e间期，Tp-e/QT与ICD一级预防患者发生恶性室性心律失常的关系

目的：探讨心电图T波峰末间期（Tp-e）及T波峰末间期与QT间期的比值（Tp-e/QT）与ICD一级预防患者发生恶性室性心律失常的关系。方法分析我院2011年3月~2014年2月因严重慢性心功能不全（左室射血分数≤35%,纽约心功能分级为Ⅱ/Ⅲ级,且既往从未发生过室速或室颤等恶性心律失常）接受ICD（植入式心脏复律除颤器）一级预防的患者68例,对所有的患者随访18~38个月（平均26个月）。在随访过程中,患者根据是否发生终点事件分为高危组及低危组;本研究以SCD或室颤、室速作为终点事件。术前对所有的患者进行12导联心电图、心脏彩超、24 h动态心电图等检查,并分析Tpeak-Tend间期及（Tpeak-Tend）/QT。结果随访过程中,因ICD识别持续性室速或室颤而引发恰当放电的患者共11例,由ICD发现非持续性室速而不需治疗的患者共7例,故高危组患者共18例。从未发生室速或室颤者共50例为低危组。高危组患者的（Tp-e）105±15 ms明显高于低危组90±17 ms（P=0.003）;（Tpeak-Tend）/QT比值在高危组与低危早组相比有明显的统计学差异（0.27±0.04 vs 0.22±0.05,P=0.002）. TpTe/QT≥0.255预测ICD一级预防患者发生恶性室性心律失常风险的敏感性和特异性分别为72.2%和65.9%;TpTe≥103 ms预测ICD一级预防患者发生恶性室性心律失常风险的敏感性和特异性分别为66.7%和67.9%。结论 Tp-e间期、Tp-e/QT比值与ICD一级预防患者发生恶性室性心律失常的关系密切,Tpeak-Tend间期及Tp-e/QT比值越大,ICD一级预防患者发生恶性室性心律失常如室速、室颤的可能性越大。     

Transvenous pectoral implantation of single lead implantable cardioverter defibrillator

Objective To report our initial experience of transveneous pectoral implantation of fingle lead implantable cardioverter defibrillator(ICD) in fifteen patients. Methods　Fifteen patients (male 13, female 2, mean age of 51.7 years), including dilated cardiomyopathy in 4, hypertrophic cardiomyopathy in 2, coronary artery disease in 5 and syncope of unknown etiology in 2, underwent ICD implantation. Indications for ICD implantation were ventricular fibrillation (8 patients) and refractory ventricular tachycardia (7 patients). All patients had syncope out of hospital. The ICD system were Medtronic Jewel active can in 5 patients (Model 7219C in 2, 7220C in 3) and CPI Ventak PRxⅢ in 9 patients. For active can, shocks were delivered through distal coil to ICD shell and for PRxⅢ through the endotak lead of proximal to distal coil. Successful implantation criteria was 2 consecutive defibrillation at less than 24 J. Results　All 15 patients had successful implantation using single lead ICD system in catheter laboratory. The mean defibrillation threshold was 12.8 J (5-15 J) and R wave was 9.9 mV (3.7-14.6 mV). All devices were of pectoral implantation. No operative and perioperative complications occurred. In 7.6 months (1-18 months) of follow-up, 3 patients had VT terminated by antitachycardia pacing (ATP) and 1 patient VF terminated by shock. Conclusion　Transveneous pectoral implantation of single lead ICD is easy to perform and has high defibrillation efficacy and should be a preferred approach.     

Antiarrhythmic drugs and ventricular defibrillation energy requirements

PURPOSE: To understand the potential interaction between antiarrhythmic therapy and the implantable cardioverter-defibrillator (ICD) in patients who receive pharmacologic therapy as an adjunct to ICD therapy. DATA SOURCES: MEDLINE searching was employed and the information was indexed from approximately 3600 journals published world-wide from 1966 to 1998. STUDY SELECTION AND DATA EXTRACTION: Data were collected from 66 of approximately 455 originally identified articles and abstracts using explicit methodological criteria. RESULTS: The ICD therapy has been widely used for therapy of life-threatening ventricular arrhythmias (VT/VF) and prevention of recurrence of sudden cardiac death. Studies reported that 40%-70% or 10%-40% of ICD patients required concomitant antiarrhythmic medication to reduce the frequency of sustained arrhythmic episodes and to minimize the frequency of device discharges. Most studies on antiarrhythmic drug-ICD interactions have been performed in experimental animals. Antiarrhythmic drugs can influence the effectiveness of ICD to terminate arrhythmias through their effects on defibrillation threshold (DFT). Studies have demonstrated a rise in DFTs with class Ib agent lidocaine and class Ic agents encainide and flecainide. Class Ia agents, as well as amiodarone, bretylium and propafenone may have more variable effects on DFT probably because of the difference between acute and chronic drug dosing, dose-related changes, active metabolites, and reproducibility in determining DFT. Class III agents, with the exception of amiodarone, consistently decrease DFT. These drugs can be used as front-line agents in ICD patients. CONCLUSIONS: Antiarrhythmic drugs can increase, decrease, or have no effect on DFT. Class III agents except amiodarone can be safely administered in conjunction with ICD patients as long as the interaction between these therapeutic modalities is appreciated.     

TERMINATION OF REFRACTORY TACHYARRHYTHMIAS BY CARDIAC PACING A REPORT OF 25 CASES

2a cases of tachyarrhythmia refra.ctory to medical t:eatment or direct current countershock were treated by overdrive cardiac pacing. O'f these, 13 were paroxysmal ventricular tachy- cardia (PVT) and/or ventricular fibrillation (VF), 8 complete atrioventricular (A-V) block with PVT and/or VF and 4 sick sinus syndrome (SSS) with pa.roxysmal supraventricular tachy- cardia. The basic cardiac disturbance was coronary heart disease (CHD) 11 cases; drug poisoning 7 cases; myocarditis 4 cases, congenital hea.rt disease 2 cases and primary cardiomyo- pathy l case. In all case's, tachyarrhythmias were successfully terminated almost immediate- ly by cardiac pacing. There were 7 hospital deaths, 3 due to recurrent VF not controlled by pacing and 4 to causes other than tachyarrhyth- mia. The authors believe that cardiac pacing is the method of choice for tachyarrhythmias.     

恶性心律失常行植入型心律转复除颤器治疗的围手术期护理

目的探索恶性心律失常行植入型心律转复除颤器（ICD）治疗的围手术期护理特点。方法选择20例恶性心律失常行ICD治疗的患者,术前进行有效的心理护理,做好术前准备,术中严密监测并配合心室颤动（VF）除颤阈值测试,术后护理及出院指导。结果本组20例患者手术均成功,无护理不当并发症。随访1-13个月,无电极脱位和死亡。结论个体化地针对恶性心律失常行ICD治疗患者的围手术期护理、定期随访,可以增强患者及家属接受ICD治疗、预防猝死的信心,改善患者生存质量。     

室性早搏密度的自发变动

本文应用动态心电图,探讨了22例室性早搏密度自发变动的特性。结果表明:室性早搏密度越高,自发变动程度越小;小时与小时之间较天与天之间室性早搏密度的变动幅度更大;相隔8天以内,天与天之间室性早搏密度的变动无明显差异,室性早搏密度呈昼夜节律分布,高峰出现在日间。研究结果将为非侵入性药效评价方法设计提供依据。     

埋藏式心脏复律除颤器防治心脏性猝死的价值

１例扩张型心肌病患者因反复发作性室性心动过速（ＶＴ）伴晕厥而植入埋藏式心脏复律除颤器（ＩＣＤ），术后随访６个月，患者自发ＶＴ／ＶＦ７次，均被ＩＣＤ放电而有效地终止，提示ＩＣＤ能有效防治心脏性猝死。     

山羊急性心肌缺血时恶性心律不齐的发生和...

The coronary collateral circulation of goat is very spare, so myocardiac ischemia model of goat can simulate the patient previously with normal coronary circulation and suddenly developing complete occlusion of coronary arteries. In this study 80 Chengdu goats were used, and the branches of their left coronary artery were ligated. Ventricular tachycardia (VT) developed in 23 goats and ventricular fibrillation (VF) in 39 goats. VT and VF both occurred in the early phase of acute myocardial ischemia, and both had 6 min as the median time of onset. In 71 cases data on the weight of myocardiac ischemic area were collected, in which the weight percentage of ischemic area relating to the ventricles of 34 goats with VF was significantly higher than that of 37 goats without VF (35.4 +/- 2.4% vs 19.5 +/- 1.9%). After coronary ligation, 9 cases directly precipitated into VF which could not be defibrillated. In the remaining 62 cases, the weight percentage of ischemic area of 21 cases with VT was higher than that of 41 cases without VT (32.9 +/- 2.8% vs 20.9 +/- 2.1%). The relationships between the incidence of VT or VF and the weight percentage of ischemic area were fitted with logistic curve. The likelihood of occurrence of VT or VF is increased as the weight percentage of ischemia area goes up.     

240例病毒性心肌炎室性早搏日分布的中医病理节律研究

目的:运用中医时间医学理论阐释病毒性心肌炎患者室性早搏24 h的分布规律,为确定合理的给药时间提供科学的依据.方法:240例病毒性心肌炎患者行24 h动态心电图监测,运用中医五脏主时节律等理论对患者室性早搏分布的节律性变化进行研究.结果:病毒性心肌炎患者室性早搏普遍高发于寅、卯、辰、巳四个时辰,尤以卯时为甚;酉、戌、亥三个时辰为室性早搏发生的低谷时段.随着年龄的增长,病毒性心肌炎患者室性早搏夜半时段的发生频度增加.不同证型的病毒性心肌炎患者其室性早搏发作的高峰时段不同.邪热犯心证患者,室性早搏多高发于日中时段;阴虚火旺证患者,室性早搏多高发于白天,日中时段加重;心气阳虚证患者,室性早搏多高发于平旦和夜半时段.结论:病毒性心肌炎患者室性早搏日分布具有明显的中医病理节律,不同证型的室性早搏,其日分布的节律亦不相同,可指导临床辨证施治.     

Fish oil supplementation and risk of ventricular tachycardia and ventricular fibrillation in patients with implantable defibrillators: a randomized controlled trial

Context  Clinical studies of omega-3 polyunsaturated fatty acids (PUFAs) have shown a reduction in sudden cardiac death, suggesting that omega-3 PUFAs may have antiarrhythmic effects. Objective  To determine whether omega-3 PUFAs have beneficial antiarrhythmic effects in patients with a history of sustained ventricular tachycardia (VT) or ventricular fibrillation (VF). Design and Setting  Randomized, double-blind, placebo-controlled trial performed at 6 US medical centers with enrollment from February 1999 until January 2003. Patients  Two hundred patients with an implantable cardioverter defibrillator (ICD) and a recent episode of sustained VT or VF. Intervention  Patients were randomly assigned to receive fish oil, 1.8 g/d, 72% omega-3 PUFAs, or placebo and were followed up for a median of 718 days (range, 20-828 days). Main Outcome Measures  Time to first episode of ICD treatment for VT/VF, changes in red blood cell concentrations of omega-3 PUFAs, frequency of recurrent VT/VF events, and predetermined subgroup analyses. Results  Patients randomized to receive fish oil had an increase in the mean percentage of omega-3 PUFAs in red blood cell membranes from 4.7% to 8.3% (P<.001), with no change observed in patients receiving placebo. At 6, 12, and 24 months, 46% (SE, 5%), 51% (5%), and 65% (5%) of patients randomized to receive fish oil had ICD therapy for VT/VF compared with 36% (5%), 41% (5%), and 59% (5%) for patients randomized to receive placebo (P = .19). In the subset of 133 patients whose qualifying arrhythmia was VT, 61% (SE, 6%), 66% (6%), and 79% (6%) of patients in the fish oil group had VT/VF at 6, 12, and 24 months compared with 37% (6%), 43% (6%), and 65% (6%) of patients in the control group (P = .007). Recurrent VT/VF events were more common in patients randomized to receive fish oil (P<.001). Conclusion  Among patients with a recent episode of sustained ventricular arrhythmia and an ICD, fish oil supplementation does not reduce the risk of VT/VF and may be proarrhythmic in some patients.      

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.