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…     

Late lead fungal endocarditis of automatic implantable cardioverter defibrillator

Lead related infective endocarditis of impantable cardioverter defibrillator occuring after few months of implantation is a rare entity. We present a case presenting after 2.5 years of implantation, which presented with a very short febrile illness and inappropriate shocks from device due to sinus tachycardia. Though patient underwent a successful surgical excision of lead with vegetation but succumbed to ventricular arrhythmic storm.     

Indications for an implantable cardioverter/defibrillator

The implantable cardioverter/defibrillator (ICD), which uses antitachycardia pacing or shock, is the only adequate therapeutic option for life threatening ventricular tachyarrhythmias. The results of prospective, randomised ICD trials show that the indications for primary and secondary prevention of sudden cardiac death have changed in a relevant manner. After the identification of a patient at risk, the implantation of an ICD reduces cardiac and total mortality significantly. A clear diagnostic procedure and the parameters needed for the identification of this risk are essential. We report on the indications for the implantation of an ICD following current guidelines in order to enable the physician to provide his patients with an adequate ICD therapy in everyday practice.     

Death due to an implantable cardioverter defibrillator

Inappropriate therapy due to noise oversensing caused a true ventricular fibrillation (VF) and death of a patient. A 49-year-old patient with a history of dilated cardiomyopathy received a double-chamber implantable cardioverter defibrillator (ICD) in 1991 for a sustained inducible ventricular tachycardia (VT). One appropriate shock delivered in 1994 terminated an episode of VT. The generator was replaced in 1995 and in 2000, and was connected to the initial leads. Three months after the second replacement, the patient received six consecutive shocks related to detection of noise interpreted as VF. Unfortunately, the sixth shock triggered a true VF, which was not treated due to end of the therapeutic sequence, and the patient died. The causes of the dysfunction are discussed.     

Role of transesophageal echocardiography in detecting implantable cardioverter defibrillator lead infection

Implantable cardioverter defibrillator (ICD) lead infection is a rare condition with reported incidence of 0.2% to 16%. It usually presents with persistent bacteremia or fever of unknown origin and requires high clinical suspicion for diagnosis. Whenever ICD lead infection is suspected, transesophageal echocardiography is the diagnostic technique of choice for detection and characterization of the lesions. Lead infections are extremely difficult to manage conservatively and surgical removal of the entire defibrillator system is recommended along with antimicrobial therapy. We describe a case of recurrent staphylococci bacteremia due to an ICD lead infection in a patient with arrhythmogenic right ventricular dysplasia.     

植入型心律转复除颤器治疗的适应证

致命性室性心律失常（室性心动过速／心室颤动）是心脏性猝死（SCD）的主要原因，美国每年约40万人死于此症。一系列多中心临床试验证明ICD是优于药物的有效治疗方法，明显降低SCD发生率。美国每年上万人安装ICD，其数量呈直线上升趋势。我国由于经济条件和认识水平普及的限制，采用ICD治疗的患者甚少，但近年来逐渐增多，1年约100例患者安装ICD。为提高医生和患者对应用ICD的认识及使用规范化，两个学会的ICD专家组于2001年11月在北京召开研讨会，就ICD适应证、多中心试验结果、植入技术、心动过速的识别和治疗、并发症、随诊等专题，结合我国实际情况，进入了深入和认真的讨论，并提出建议。     

植入型心律转复除颤器10例的临床随访

缺血性心肌病心脏性猝死（SCD）的直接原因大多为室性心动过速（室速）或心室颤动（室颤），尤其合并左心室功能减退的心力衰竭时，SCD的发生率明显增高。植入型心律转复除颤器（ICD）同时具有电击复律和抗心动过速起搏治疗的功能，国外的大规模多中心临床研究表明ICD能够显著降低SCD的发生。我院联合浙江医院自2003年以来用ICD治疗此类患者，取得较好疗效，现报告如下。     

Economic implications and cost-effectiveness of implantable cardioverter defibrillator and cardiac resynchronization therapy

Use of implantable cardioverter defibrillators (ICDs) and/or cardiac resynchronization therapy reduces mortality among several high-risk cohorts, primarily those with left ventricular systolic dysfunction and heart failure. Since the advent of these technologies, concerns regarding the high initial costs of device implantation have been considered a potential barrier to widespread adoption. Despite such concerns, the use of these devices for primary or secondary prevention of sudden cardiac death seems to be cost-effective when compared with national standards. Moreover, ICDs have been shown to be cost-effective in several health care systems and specialized populations such as those with high-risk long QT syndrome and hypertrophic cardiomyopathy.     

植入型心律转复除颤器的临床应用

自从植入型心律转复除颤器（implantable cardioverter defibrillator，ICD）诞生以来，许多临床实验已经证实了它能够有效地预防心脏性猝死（包括二级预防和一级预防），其功能是一旦有持续性室性心动过速（VT）和／或心室颤动（VF）的发作，能在几秒内识别并有效终止。我院自2000年以来共植入ICD7例。     

Near fatal arrhythmia induction by an implantable cardioverter defibrillator

Sudden death among implantable cardioverter defibrillator (ICD) recipients is well known. The underlying mechanism remains unclear in most cases. One possible mechanism is an accidentally induced arrhythmia by the ICD itself. This report describes for the first time a case of a life-threatening ventricular arrhythmia induced by a specific algorithm for ventricular arrhythmia reconfirmation before shock delivery in a fourth-generation ICD.     

Indications for an implantable cardioverter defibrillator (ICD)

Since the first clinical use of implantable defibrillator in human, the technology and the function of implantable cardioverter-defibrillator (ICD) have been much improved and now, ICD can be implanted within the chest wall. ICD is the most reliable therapy to prevent sudden cardiac death (SCD) in patients with documented VT/VF and the efficacy is most clear in patients with depressed heart function. It is now extended as a tool of the primary prevention of SCD in high risk patients after myocardial infarction. However, such beneficial effect is not applicable to DCM though patients might have depressed heart function. ICD is not free from procedure- or device-related problems which need to be resolved. From unknown causes, VT/VF might recur in an incessant form and an emergency admission is needed. Therefore, even during ICD therapy, patients often require antiarrhythmic drugs or catheter ablation.     

Asymptomatic right ventricular perforation by an implantable cardioverter defibrillator lead detected by home monitoring system

Right ventricular lead perforation is a rare but serious and potentially life-threatening complication of pacemaker or defibrillator lead implantation. This report describes a patient with Brugada syndrome in whom the diagnosis of asymptomatic right ventricular perforation by an implantable cardioverter defibrillator lead was detected 12 days after implantation, thanks to a report from home monitoring system. The patient was admitted to our institution, where the lead was explanted and replaced. This case illustrates the potential lifesaving benefit of the home monitoring system in patients with implantable cardioverter defibrillator.