Clinical experience in patients with implantable cardioverter defibrillators

Forty patients (36 men and 4 women) with life-threatening arrhythmia received an implantable cardioverter defibrillator (ICD). Mean age was 63 years (range, 46 to 80 years). All patients had structural heart disease, with coronary artery disease in 32 patients, idiopathic cardiomyopathy in 7 patients, and hypertensive heart disease in 1 patient. Mean left ventricular ejection fraction was 29 +/- 13%. The clinical arrhythmia was out-of-hospital cardiac arrest in 14 patients (35%), symptomatic sustained ventricular tachycardia in 21 patients (53%), and episodes of syncope without documented spontaneous ventricular arrhythmia but ventricular tachycardia that was easily provoked at the time of electrophysiologic testing in 5 patients (13%). Sustained ventricular tachycardia was induced in 37 patients (93%) at basic electrophysiologic testing. The average number of drug failures was 2.9 +/- 1.4 per patient. One patient (2.5%) died perioperatively because of intractable ventricular tachycardia and ventricular fibrillation. During a median follow-up period of 5.5 months (range 2-21 months) 2 sudden deaths occurred. No patient had a serious complication during the follow-up period. Ten patients (25%) received antiarrhythmic drugs to suppress spontaneous ventricular tachycardia. Appropriate shock treatment was received by 18 patients (45%), and inappropriate shock treatment was received by 2 patients (5%). Several issues regarding use of the ICD must be considered, but the device seems to be useful, and it is associated with an acceptable rate of complications and good long-term success at the present time.     

植入埋藏式心脏复律除颤器患者的电风暴

埋藏式心脏复律除颤器(ICD)预防心源性猝死,提高患者生存率。电风暴是ICD植入后可能出现的一种严重室性心律失常事件,不仅缩短ICD的寿命,还提示患者预后不良。文章就电风暴的定义、发生率、长期预后、促发因素及治疗进行综述。     

埋藏式心脏转复除颤器的随访

目的报道37例埋藏式心脏转复除颤器(ICD)的随访结果。方法对置入ICD的37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37例患者共发作室性心动过速/心室颤动(VT/VF)917次(VT745次,VF172次),其中911次(99.3%)治疗成功,6次(0.7%)失败。非持续性VT122次(16.4%),发作均自行停止。623次持续性VT(83.6%)中,537次(86.2%)经抗心动过速起搏(ATP)终止,82次(13.2%)经低能量复律(CV)终止,3次(0.4%)在ATP治疗过程中加速为VF,由高能量除颤(DF)终止。172次VF中,167次(97.1%)经DF终止,1例无效放电5次(2.9%)系因电池提前耗竭而更换了ICD脉冲发生器,2例共8次阵发性心房颤动心室率超过设置的VT频率ICD发生误识别,给予ATP治疗。5例术后1~6个月出现心律失常“电风暴”。5例对电击恐惧造成了不同程度的心理障碍,经教导必要时辅以药物治疗后症状得以缓解。共有19例术后因VT发作频繁而服用胺碘酮/美托洛尔,并根据心律失常发作情况调整用药剂量。结论ICD置入后应加强随访,及时调整工作参数,同时辅助药物、改善心功能和心理治疗。     

Quality of life in pediatric patients with implantable cardioverter defibrillators

Psychosocial and quality-of-life (QOL) outcomes in adult patients with implantable cardioverter-defibrillators (ICDs) are well studied. Minimal research exists regarding pediatric adjustment, despite a potentially more challenging adjustment process. The purpose of the present study was to examine psychosocial and QOL functioning of pediatric ICD patients from patient and parent self-reports. Children and primary caregiver dyads from several university hospitals were analyzed using the PedsQL, the Device Severity Index, the ICD and Avoidance Survey, and demographic information. Sixty children (25 female, 35 male) were enrolled. The present pediatric sample reported lower psychosocial and physical QOL scores than healthy children's normative scores. In comparison with a sample of chronically ill children, pediatric ICD patients reported lower physical QOL. Parent-observed QOL reports revealed lower psychosocial and physical QOL than parent-observed healthy norms and lower psychosocial and physical QOL than chronically ill norms. There were no QOL differences by ICD shocks or medical severity. Female patients reported lower psychosocial, physical, and cardiac QOL scores. Children reported better QOL than parent observations on psychosocial and physical health. Finally, 84.7% of children reported avoidance behaviors since ICD implantation, with female children avoiding places more than male children. In conclusion, pediatric ICD patients are comparable to children with other chronic illnesses with the exception of lower physical QOL. Similar to adult samples, female children reported poorer QOL and were more likely to engage in avoidance behaviors. Patients indicated better QOL perceptions than their parents' reports. ICD discharges and medical severity did not negatively affect QOL.     

Advances in implantable cardioverter defibrillators.

Implantable cardioverter defibrillators (ICDs) have become an important therapeutic modality for patients who have had a cardiac arrest or are at risk for life-threatening ventricular arrhythmias. Clinical trials have confirmed the role of the ICD for patients with sustained ventricular arrhythmias and have expanded the indications to include patients with coronary artery disease, left ventricular dysfunction, nonsustained ventricular tachycardia, and inducible ventricular tachycardia. Numerous technologic advances in ICDs have resulted in decreased size, greater ease of placement, and increased functionality. Important advancements have been made in the effectiveness of arrhythmia classification and electrogram storage. Dual-chamber ICDs have become increasingly sophisticated with rate-adaptive sensors. Biventricular pacing is being combined with ICD function in patients with heart failure, systolic dysfunction, and QRS widening. Future advances in devices will likely lead to improved arrhythmia classification, more advanced automated features, and additional features including more sophisticated sensors and biventricular pacing systems.     

植入心律转复除颤器后发生电风暴一例

植入型心律转复除颤器（ICD）电风暴由严重的室性心律失常引起，最常见于植入ICD的早期，是植入ICD后所特有的现象，即发生了需要多次转复的快速、成簇的室性心动过速（室速）或心室颤动（室颤）。[第一段]     

69例植入型心律转复除颤器治疗患者的随访

目的 对全国50家医院69例植入型心律转复除颤器（implantable cardioverter defibrilla-tor,ICD)的患者通过较长期随访获得的实际经验,以期促进和提高我国ICD的应用水平。方法 资料来自全国50家医院的门诊随访、电话询问或厂家随访,通过常规心电图、动态心电图及ICD程控分析仪调出的资料,对串屠 情况及ICD工作情况进行分析,结果 平均随访2.3年中有30例患者接受成功的ICD治理,占全组患者43.5%,总共发作快速心律失常276次,其中VT236次占85.5%,VF40次占14.5%,VT由ATP终止135次,占57.2%,由CV终止101次,占42.8%,VF经DF（除颤）40次,全部一次成功,2例VT加速转成VF,2例无休止发作VT,电击成功,但瞬间又转为VT,2例服胺碘酮后VT频率减慢（140-100次/min),69例中有6例死亡,其中半数因心力衰竭加重所致,结论 ICD的治疗效果肯定,需加强随访及时修改参数,更准确地识别和治疗快速室性心律失常,同时需注意药物的辅助治疗,积极改善心功能,还应加强对患者的心理教育。     

心律转复除颤器植入术后电风暴的发生及其对预后的影响

目的调查单中心心律转复除颤器（ICD）植入术后电风暴（ES）的发生率、发作特征和危险因素,并探讨其对患者预后的影响。方法对本中心123例植入ICD的患者进行随访。Es定义为24h内出现3次或3次以上的快速室性心律失常（VA）导致ICD治疗,或ICD监测到持续30s以上的VA但未发放治疗。结果在（26．9±21．3）个月的随访期间,共有41（33．3％）例患者（ES组）发作139次ES（3．4±3．9）次／例,其中29（70．7％）例患者的首次发作在植入后1年内出现,Es发作呈现出6：00—10：00和14：00～17：00两个高峰。多因素Logistic回归分析表明植入ICD作为心脏性猝死二级预防是ES发生的独立危险因素（OR=4．797,P=0．044）。本组共15（12．2％）例患者死亡,Es组死亡率较无Es组（24．4％对6．1％,P=0．003）显著增高,Kaplan—Meier生存曲线分析显示Es组累计生存概率明显低于无Es组（Log—rank检验P〈0．001）。结论Es发作表现为上午和下午两个高峰,可导致死亡率增高,其首次发作多在ICD植入后1年内。植入ICD作为心脏性猝死二级预防是Es发生的独立危险因素。     

Azimilide decreases recurrent ventricular tachyarrhythmias in patients with implantable cardioverter defibrillators

OBJECTIVES: This study evaluated the effects of azimilide dihydrochloride (AZ) on anti-tachycardia pacing (ATP) and shock-terminated events in patients with implantable cardioverter defibrillators (ICDs). BACKGROUND: Animal studies have shown the effectiveness of AZ for therapy of supraventricular and ventricular tachycardia (VT). Azimilide dihydrochloride was investigated as adjunctive treatment for reducing the frequency of VT and, thus, the need for ICD therapies, including ATP and cardioversion/defibrillation (ICD shocks) in patients with inducible monomorphic VT. METHODS: A total of 172 patients were randomized to daily treatment with placebo, 35 mg, 75 mg, or 125 mg of oral AZ in this dose-ranging pilot study of patients with ICDs. The majority of patients had a history of documented remote myocardial infarction and congestive heart failure New York Heart Association class II or III. RESULTS: The frequency of appropriate shocks and ATP were significantly decreased among AZ-treated patients compared with placebo patients. The incidence of ICD therapies per patient-year among the placebo group was 36, and it was 10, 12, and 9 among 35 mg, 75 mg, and 125 mg AZ patients, respectively (hazard ratio = 0.31, p = 0.0001). Azimilide dihydrochloride was generally well tolerated and did not affect left ventricular ejection fraction or minimal energy requirements for defibrillation or pacing. CONCLUSIONS: Azimilide dihydrochloride may be a safe and effective drug for reducing the frequency of VT and ventricular fibrillation in patients with implanted ICDs.     

植入型心律转复除颤器植入术后患者心理适应不良分析

目的对接受植入型心律转复除颤器(ICD)后患者心理适应不良的原因及改善方法进行分析探讨。方法69例持续性室性心动过速或心室颤动患者接受ICD治疗，根据患者室性心动过速或心室颤动发作时频率及对血流动力学的影响确定治疗方法和参数。结果在随访过程中发现4例患者在接受过电击治疗后出现严重的心理适应不良，包括紧张、情绪低落、恐惧及性功能障碍等，严重影响患者的生活质量。结论ICD放电可引起患者心理适应不良，期望通过ICD参数的调整、加强内科药物治疗及心理干预改善这些患者的心理状态。     

埋藏式心脏转复除颤器电击治疗的预测因素分析

目的探讨植入埋藏式心脏转复除颤器(ICD)患者电击治疗的预测因素。方法回顾性分析25例植入ICD患者的基础特征,将患者是否进行了ICD治疗分为治疗组和未治疗组,比较两组特征,并采用logistic回归分析电击的预测因素。结果随访18.8±14.3个月后,其中8例共经历21次电击。ICD电击治疗的发生与左室射血分数相关(r=1.129,P=0.030),与年龄、性别、缺血性心脏病、室性心动过速消融、胺碘酮及β受体阻滞剂无相关。多变量COX分析证实左室射血分数(HR 1.08,95%CI 1.07～1.09,P=0.016)是发生电击治疗的独立预测参数。结论严重左室收缩功能障碍的ICD患者容易出现电击治疗。     

Uncertainty is a major concern for patients with implantable cardioverter defibrillators

Objective

The study objective was to explore the main concern of individuals living with an implantable cardioverter defibrillator (ICD) and how they handle this in daily life. For improved management and follow-up, it is important to understand how the ICD affects the recipient’s daily life.

Methods

A grounded theory method was used. Sixteen Swedish recipients (9 men) living with an ICD for 6 to 24 months were interviewed.

Results

The core category labeled, “Incorporating uncertainty in daily life,” illuminates the main concern. To handle uncertainty, recipients used the following strategies: restricting activities, distracting oneself, accepting being an ICD recipient, and reevaluating life.

Conclusion

Recipients were not paralyzed by uncertainty. Instead, they incorporated uncertainty in life by using strategies to handle their daily life. Questions, comments, and plans for supportive communication were provided, which can be used by healthcare professionals in cardiac rehabilitation.     

Use of implantable cardioverter defibrillators in patients with left ventricular assist devices

Patients with left ventricular assist devices (LVADs) are at high risk of sustained ventricular arrhythmias, but these may be remarkably well tolerated and the association with sudden death is unclear. Many patients who receive an LVAD already have an implantable cardioverter defibrillator (ICD). While it is standard practice to reactivate a previously implanted ICD in an LVAD recipient, this should include discussion of the revised risks and benefits of ICD therapy following LVAD implantation. In particular, patients should be warned that they might receive a significant number of ICD shocks that may not be life saving. When ICDs are reactivated, device programming should minimize the risk of repeated shocks for non-sustained or well-tolerated ventricular arrhythmias. Implantation of a primary prevention ICD after implantation of an LVAD is not supported by current evidence, poses potential risks, and should be the subject of a clinical trial before it becomes standard practice.     

窦性心动过速引起植入型心律转复除颤器误放电

目的观察和分析植入型心律转复除颤器（ＩＣＤ）误放电的发生情况。方法对植入ＩＣＤ患者进行随访,应用体外程控仪调出ＩＣＤ存储的资料进行分析。结果３１例植入ＩＣＤ患者随访平均１０个月中,２例患者因窦性心动过速发生ＩＣＤ误放电８次。１例发生在运动过程中,１例发生于静脉滴注多巴酚丁胺时,经程控ＩＣＤ的室性心动过速识别参数后,未再发生误放电。结论植入ＩＣＤ的患者可能会发生误放电,定期的随访及调整合适的ＩＣＤ参数,可避免和减少ＩＣＤ误放电的发生。