恶性室性心律失常的现代治疗

心源性猝死是心血管疾病的主要死亡原因之一 ,由于从发病至死亡时间短 ,来不及到医院就诊 ,得不到及时抢救 ,患者多死于医院以外。无论患者有无器质性心脏病或患何种类型心脏病 ,患者猝死的直接原因主要是心律失常 ,其中 80 %以上是有血流动力学障碍的室性心动过速或室颤 ,即所谓恶性室性心律失常 ,另外不足 2 0 %的患者死于缓慢心律失常。因此 ,预防心脏性猝死的关键是早期发现患者有发生恶性室性心律失常的高危因素 ,并进行积极治疗 ,对于已经发生过因室速或室颤而心脏骤停的患者应采取更为积极的措施。1　室性心律失常的分类和危险分层我…     

恶性室性心律失常急诊电复律治疗的护理

恶性室性心律失常(室颤、快速或多形性室速)是心源性猝死的主要原因,严重威胁病人的生命健康,治疗措施是尽早电复律[1]。现场使用电复律比药物治疗起效快,可赢得治疗时间,它是利用高能脉冲直接或经胸壁作用于心脏,使心脏各部位心肌在瞬间同时除极,从而中断折返,由窦房结重新控制     

胺碘酮治疗恶性室性心律失常病人的护理

胺碘酮属于Ⅲ类抗心律失常药 ,它兼有各类抗心律失常药物的某些特点 ,被视为一种广谱抗心律失常药 ,静脉给胺碘酮起效快速、无明显的血流动力学影响 ,且对利多卡因和普鲁卡因酰胺治疗无效的室性心动过速 (室速 )或心室纤颤 (室颤 )有效 ,对服用其他抗心律失常药物无效的恶性室速或室颤的控制率可达6 0 %～ 80 %[1] 。目前认为胺碘酮对于预防和控制致命性室速 ,特别是心肌梗死后发生的室速是最有效的药物之一 ,且胺碘酮具有对心脏的全面保护作用 ,可降低心功能衰竭病人心律失常相关死亡风险 ,并可改善心功能 ,目前临床应用日渐增加。我院IC…     

恶性室性心律失常的防治

恶性或致命性室性心律失常(室性心动过速／心室颤动,VT／VF)是心脏性猝死(SCD)的主要原因,美国每年约40万人死于此症,德国有8-10万人。我国虽无准确的统计数字,但由于人口总数大,估计心脏性猝死的绝对数字不会小。因此防治恶性室性心律失常也就成了降低猝死率的中心议题。     

ICD起搏器安置术5例的术后护理

心脏性猝死最有效的预防方法是安置植入型心律转复除颤器(ICD).2006-07/2008-03我院5例患者进行了ICD起搏器安置术,取得了良好治疗效果,现将术后护理总结如下.     

自动体外除颤器治疗恶性室性心律失常59例的护理

现就我院心脏监护病房(CCU)采用HeartStart MRx半自动体外除颤器(AED)模式治疗59例恶性心律失常的护理体会总结如下。1临床资料1.1一般资料选择2007-07-2010-12收住本院CCU病房经过监护明确有恶性室性心律失常患者59例。其中急性心肌     

恶性室性心律失常的处理要点

室性心律失常临床上常见，其临床表现差异很大，有的无临床意义，有的则影响健康并危及生命，如恶性室性心律失常。因而首先要判定室性心律失常的恶性程度，选择药物治疗或非药物治疗，如需药物治疗，以选择何种药物为最佳。要熟知所选药物的药代动力学、药效学及其对心脏电生理的影响。合理选用抗心律失常药物和及时识别抗心律失常药物所致的心律失常。     

静脉注射胺碘酮治疗恶性室性心律失常

目的观察静脉注射胺碘酮治疗恶性室性心律失常的临床疗效。方法对22例恶性心律失常患者,在常规治疗的基础上或电复律成功后及心电监护下,静脉应用胺碘酮治疗,观察其临床疗效及不良反应。结果21例患者的恶性室性心律失常好转,总有效率为95.5%;用药期间死亡1例。结论静脉注射胺碘酮治疗恶性室性心律失常患者安全可靠,不良反应小,值得临床推广应用。     

恶性室性心律失常导管消融现状

室性心动过速尤其是器质性室性心动过速和心房纤颤为2大严重心律失常.心房纤颤导管消融临床应用较多,而器质性室性心动过速尤其是血流动力学不稳定室性心动过速和直接导致猝死的心室颤动等恶性室性心律失常的导管消融方面的进展较慢,这很大程度上是因有埋藏式心脏复律除颤器作为首选,同时有伦理和法律方面原因,本文就恶性室性心律失常导管消融现状做一概述.     

Survival in Patients with Depressed Left Ventricular Function Treated by Implantable Cardioverter Defibrillator

Mortality in patients with cardiovascular disease is generally due to pump failure or lethal ventricular arrhythmias, In patients with ventricular tachycardia (VT) or ventricular fibrillation (VF) and poor left ventricular (LV) function the death rate is particularly high. The overall incidence of premature arrhythmic death rate in patients with poor LV function is not totally clear. Since implantable cardioverter defibrillator (ICD) could prevent arrhythmic death in any population, we proceeded to analyze mortalities in patients with poor LV function who received ICD. Among a total of 200 consecutive patients receiving ICD at our institution, 68 (34%) had LV ejection fraction (LVEF) of < 30%. Thirty-one of these (45%) experienced appropriate ICD discharges and 17/31 (55%) had multiple shocks. Survival curves in this population revealed a 5 year projected overall survival of 11% whereas an actual survival was 60%. Even those who ultimately died from nonsudden causes, life was prolonged by ICD in a significant number of cases. Based upon these findings it is concluded that ICD has a major impact on survival in patients with poor LV function suggesting that many of these patients die prematurely from arrhythmia causes.     

植入型心脏转复除颤器患者发生电风暴的护理体会

心脏性猝死(sudden cardiac death,SCD)通常是致命性室性心律失常的最终结局.预防室性心律失常所致心源性猝死惟一有效的方法是植入植入型心脏转复除颤器(implantable cardioverter defibrillator,ICD)以减少心脏性猝死的发生[1].ICD已经从对室性心动过速(简称室速)、心室颤动(简称室颤)进行二级预防,扩展到对低射血分数的一级预防.     

Patient Acceptance of the Implantable Cardioverter Defibrillator in Ventricular Tachyarrhythmias

Besides surgical problems, recipierifs of implantable cardioverter defibrillators (ICDs) are faced with psychological and social adjustments. Successful ICD therapy is influenced by the patients' perceived concerns regarding device, discharge, changes in life style, and complications. In order to assess patients' acceptance of the ICD, the psychological profile of 57 consecutive patients was evaluated using a specifically designed questionnaire and the State Trait Anxiety Inventory (STAI). The results showed that 20 patients staled fear of ICD discharge, 12 patients revealed physical discomfort due to the device, and limited quality-of-life occurred in 8 patients. Fifty-five of 57 patients answered that it was worth having an ICD device implanted, 30 (53%) patients returned to active life, and 56 (98%) would advise another patient to undergo implantation if necessary. Overall, there was only a slight, but insignificant, decrease in the level of anxiety within the total patient population after ICD implantation. However, a comparison of two subgroups indicated that the state of anxiety was significantly higher in patients < 50 years of age as well as in patients having received > 5 shocks versus those > 50 years of age and having experienced < 5 shocks. In general, the acceptance of the ICD as a tool in managing life-threatening ventricular tachyarrhythmias is high. Besides the increased survival rate, quality-of-life and patient acceptance are important criteria for successful ICD therapy.     

Implantable Cardioverter Defibrillator Events in Patients with Asymptomatic Nonsustained Ventricular Tachycardia:

Primary prevention trials have demonstrated that patients with coronary disease, reduced left ventricular function, and nonsustained ventricular tachycardia (NSVT) have improved survival with implantable cardioverter defibrillator (ICD) therapy, presumably secondary to effective termination of life-threatening arrhythmias. However, stored intracardiac electrograms were not always available and specific arrhythmias leading to ICD therapy were not always known. We examined the occurrence of ICD events in 51 consecutive patients who match the described patient profile to determine the frequency of appropriate and inappropriate ICD therapy. ICD detections were noted in 18 (35%) patients during a median follow-up period of 13.1 months. Appropriate therapy for sustained ventricular tachycardia (VT)/ventricular fibrillation (VF) occurred in 11 (22%) patients, with appropriate shocks in 8 (16%) patients and appropriate antitachycardia pacing (ATP) in 4 (8%) patients. The time to first appropriate therapy occurred at a mean of 17 +/- 12 months (median 18 months, range 3-36 months). Inappropriate therapy occurred in 5 (10%) patients with inappropriate shocks in 4 patients and inappropriate ATP in 2 patients. Inappropriate therapy was delivered for supraventricular arrhythmias (SVAs) in 4 patients and for T wave oversensing in 1 patient. The reason for shock therapy was unknown in 1 patient (2%) due to ICD malfunction. The mean arrhythmia rate leading to appropriate therapy for VT/VF was 232 +/- 72 beats/min (range 181-400 beats/min), and the mean rate leading to inappropriate therapy for SVT was 168 +/- 10 beats/min (range 160-180 beats/min). Patients with coronary disease and asymptomatic NSVT commonly receive appropriate defibrillator therapy. These results support the need for ICD implantation for primary prevention, with attention to careful programming of the detection rate to prevent inappropriate therapy.     

Implantable Cardioverter Defibrillator Detection During Radiofrequency Catheter Ablation of Ventricular Tachycardia

Right ventricular radiofrequency catheter ablation was performed in an ICD patient with frequent ventricular tachycardia without prior inactivation of the device. The registrations of inlracardiac ECG and marker channel were excellent during energy delivery: the surface ECG was affected. The device did not show dysfunction during and after energy delivery.     

Implantable Cardioverter Defibrillator Clinic Casualties: Inadvertent Reprogramming During Routine Implantable Cardioverter Defibrillator Follow-Up

On one occasion during a busy ICD follow-up clinic, the preceding patient's parameters for rate, PDF, and delay were inadvertently programmed into the subsequent patient's generator using the CPIProgrammer Model 2035. This occurred after capacitor reformation, without pressing the "Program" button. The source of this reprogramming error was failure to clear the programmer memory of the previous patient's data, usually achieved by turning the programmer off between patients (or selecting "New Patient" from the menu). At our next ICD follow-up clinic, we purposely did not turn off the programmer between two sets of patients. On both occasions the above finding was repeated and confirmed. These observations indicate the potential for serious reprogramming errors that can occur simply by not clearing the programmer's memory between clinic patients.     

Supraventricular Arrhythmia Induction by an Implantable Cardioverter Defibrillator in a Patient with Hypertrophic Cardiomyopathy

A 23‐year‐old woman with obstructive hypertrophic cardiomyopathy and history of frequent unexplained syncope had undergone implantable cardioverter defibrillator implantation. She had experienced frequent inappropriate shocks since implantation due to T‐wave oversensing. After one of the syncopal attacks, she was found to have an atrioventricular (AV)‐reentrant tachycardia, induced by a high‐voltage shock, with rapid degeneration to atrial fibrillation and then ventricular fibrillation. The AV‐reentrant tachycardia was believed to be the cause of both syncopal attacks and inappropriate shocks. The patient has been asymptomatic after ablation of the accessory pathway. To the best of our knowledge, this is the first report of induction of an AV‐reentrant tachycardia by a high‐voltage implantable cardioverter defibrillator shock. (PACE 2010; 33:372–376)