植入型双腔心律转复除颤器复律心房纤颤临床应用一例

心衰患者死因中30％～50％是猝死,其原因与心律失常相关,对猝死（特别是伴有室速室颤恶性的猝死）的对策尤其重要。植入型双腔心律转复除颤器（ICD）是临床用于治疗室速、室颤的有效手段,在治疗致命性室性心律失常、预防心脏性猝死的作用明显优于抗心律失常药物。最近,我院为1例心衰心功能Ⅲ～Ⅳ级反复发作室速并伴房颤的患者行双腔ICD治疗,现报道如下。     

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…     

植入型自动心律转复除颤器临床应用

心脏性猝死严重威胁心脏病患者的生命 ,其最常见直接原因为 VT和 VF。ICD是预防心脏性猝死的最有效的治疗方法。 1 980年 2月在美国霍普金氏医院 (Johns Hopkins Hospital)安装了第一台自动除颤器 ,到目前为止 ,世界上十万例患者安装了除颤器 ,挽救了数以万计患者的生命。在近六年内 ,这种治疗方法已成为标准治疗方法。越来越多的患者 ,尤其心脏骤停幸存者非常愿意接受这种治疗。仅 1 993年一年 ,美国接受 ICD植入的患者已达 1万例 ,1 995年已达 3万例。我国从 1 991年开始将 ICD应用于临床 ,迄今约有 30例患者安装了 ICD。我院1 99…     

植入型心律转复除颤器的临床随访

植入型心律转复除颤器(ICD)的应用挽救了许多因恶性室性心律失常而猝死的患者，由于心律失常的多样性、患者临床症状的复杂性、以及ICD功能的不断发展，术后随访对于ICD能否充分发挥作用起着至关重要的作用。2001年至2003年我科共植入5台ICD，临床随访结果如下。     

经静脉植入心律转复除颤器的临床应用

目的 :应用植入型心律转复除颤器 (ICD)治疗致命性室性心律失常。方法 :4例均为男性 ,年龄 39～ 74岁。 3例冠心病 ,1例扩张型心肌病 ,伴LBBB +I° AVB。药物治疗不佳。 3例冠心病植入单腔ICD ,扩张型心肌病植入双腔ICD。结果 :4例均成功植入ICD。平均起搏阈值 0 4 5v。平均R波振幅15 75mv。随访 8～ 36个月 ,3例出现快频率室速 ,经抗心动过速起搏及低能量电击治疗转复为窦律 ,平均电击能量 5 4J。 1例单腔ICD发生室上性心动过速导致误放电 ,经重新设置室速频率窗口 ,未再出现误放电。结论 :ICD能有效转复恶性室性心律失常 ,双腔ICD因增加了心房电极 ,在改善血液动力学、预防房性及室性快速心律失常 ,降低不适当ICD治疗等方面优于单腔ICD。     

非开胸植入埋藏心脏复律除颤器的临床应用

介绍非开胸植入埋藏式心脏复律除颤器（ＩＣＤ）治疗２２例患者室性心律失常的临床应用，ＩＣＤ治疗适应证包括：１７例心室颤动患者和５例顽固性心动过速患者，基础心脏病为：冠心病１３例，扩张心脏病７例，致心律失常性右室发育不良２例，２２例患者２０例成功地植入了非开胸ＩＣＤ（９１％），平均除颤阈值为１６．７±４．６Ｊ。２例未成功患者因除颤阈值偏颃是改用开胸植入ＩＣＤ，平均住院时间为７．４±３．３天，并发症为，     

埋藏式心房复律除颤器的研究进展

心房颤动(AF)是临床最常见的心律失常之一,70岁以下的人群发病率为0.4%,而70岁以上者则达到2%～4%[1]。AF影响患者的心功能、增加脑卒中的发生率和住院次数。故AF的治疗已成为众多学者研究的热点。但目前无论是药物还是非药物治疗,包括手术、消融、起搏、体外复律等均未取得理想的效果。随着埋藏式心脏复律除颤器成功地应用于恶性室性心律失常的治疗,1993年Levy等[2]提出了埋藏式心房复律除颤器(AtICD)的设想。晚近,已对AtICD进行了动物实验和临床应用。本文就其研究进展作一综述。1　At-ICD的基本功能　　AtICD基本功能为正确感…     

植入型心律转复除颤器的植入技术和随访

植入型心律转复除颤器的植入技术 我国于1992年开始在临床使用植入型心律转复除颤器(ICD),因为是开胸手术,创伤大,比较复杂,5年中仅约10例患者使用此技术。近年来由于经静脉单导线植入技术的开展,创伤小,手术简化,采用ICD治疗的病人逐渐增     

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...     

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。     

Cardiac embolism after implantable cardiac defibrillator shock in non-anticoagulated atrial fibrillation:The role of left atrial appendage occlusion

Cardioembolic events are one of the most feared complications in patients with non-valvular atrial fibrillation(NVAF) and a formal contraindication to oral anticoagulation(OAC).The present case report describes a case of massive peripheral embolism after an implantable cardiac defibrillator(ICD) shock in a patient with NVAF and a formal contraindication to OAC due to previous intracranial hemorrhage.In order to reduce the risk of future cardioembolic events,the patient underwent percutaneous left atrial appendage(LAA) occlusion.A 25 mm AmplatzerTM Amulet was implanted and the patient was discharged the following day without complications.The potential risk of thrombus dislodgement after an electrical shock in patients with NVAF and no anticoagulation constitutes a particular scenario that might be associated with an additional cardioembolicrisk.Although LAA occlusion is a relatively new technique,its usage is rapidly expanding worldwide and constitutes a very valid alternative for patients with NVAF and a formal contraindication to OAC.     

Ablation of atrial fibrillation in Brugada syndrome patients with an implantable cardioverter defibrillator to prevent inappropriate shocks resulting from rapid atrial fibrillation

Background

Inappropriate shocks resulting from atrial tachyarrhythmias are highly problematic for patients with an implantable cardioverter defibrillator (ICD). We aimed to determine the effectiveness of catheter ablation of atrial fibrillation (AF) in preventing inappropriate shocks due to rapid AF in patients diagnosed with Brugada syndrome (BS) who were implanted with an ICD.

Methods

We performed AF ablation in 5 BS patients with ICDs who experienced inappropriate shocks caused by rapid paroxysmal AF and in a BS patient scheduled to determine an indication of an ICD implantation who frequently experienced rapid AF.

Results

Although 2 patients underwent a 2nd ablation procedure because of AF recurrences, 5 of the 6 patients were finally free from AF after their last procedure during a median follow-up period of 43.2 months. No further inappropriate shocks caused by rapid AF occurred after the 1st ablation session in any of the patients. A patient developed a ventricular fibrillation storm during his electrophysiological study following the ablation procedure, and then was implanted with an ICD.

Conclusions

AF ablation in BS patients may be reasonable to prevent inappropriate ICD shocks resulting from rapid AF. However, ventricular extrastimuli just after the ablation had better be avoided in them.     

维拉帕米对阵发性房颤患者心房颤动负荷的影响

目的 :评估预防性地应用维拉帕米 （Verapam il）对安装植入型心房除颤器 （IAD）的慢性阵发性房颤患者心房颤动负荷的影响。方法 :因反复发作有症状的房颤而安装植入型体内心房除颤器 （IAD）患者 10例 ,随机交叉地进入维拉帕米 （2 40 mg/d）组或安慰剂组并持续 3个月。由 IAD储存并记录房颤发作的起始时间和每次发作的持续时间 ,必要时发放 R波同步电流进行体内除颤。结果 :93%的的症状性自发房颤片段由 IAD成功地转复。维拉帕米组体内除颤的成功率与安慰剂组比较无显著差异 （10 0 %vs88%,P=0 .8） ,且每次成功复律所发放的电击次数亦无显著差异 （1.7± 2 .4vs 1.8± 2 .1,P=0 .6 ）。房颤发作的平均次数 （8.0± 8.0 vs 9.1± 10 .8,P=0 .83） ,每次房颤发作的持续时间 （44± 84h vs45± 87h,P=0 .93）及总的房颤持续时间 （418± 5 11h vs5 86± 40 9h,P=0 .5 1） ,在安慰剂组和维拉帕米组之间无显著差异。结论 :慢性房颤患者中预防性地使用维拉帕米并不能有效地影响心房颤动的负荷。     

Impact of atrial fibrillation duration on postcardioversion recurrence

BACKGROUND: "Begetting," a mechanistic tenet of atrial fibrillation (AF), stipulates that the rate of recurrence of AF after cardioversion is proportional to the preceding arrhythmia duration. However, recent reports suggest that, for brief durations, the incidence of early recurrence of AF (ERAF) is inversely proportional to duration. These reports were based on potentially biased data. OBJECTIVES: We performed a prospective study to examine the impact of AF duration on postcardioversion recurrence. METHODS: Forty-four patients underwent placement of an implantable cardioverter-defibrillator (ICD) capable of delivering patient-elicited AF cardioversion shocks. Subsequently, in the ambulatory setting, the timing of shocks in relationship to perceived AF onset was randomly assigned within individuals to early (as soon as possible) or delayed (1 day later). RESULTS: During a follow-up averaging 199 days per patient, a total of 61 AF episodes among 17 patients occurred for which a patient-elicited cardioversion shock was delivered. Twenty-three shocks were delivered using early protocol (mean 6.8 hours after AF onset), and 38 shocks were delivered using delayed protocol (mean 34.7 hours after AF onset). The incidence of ERAF was significantly lower using the delayed protocol. CONCLUSION: A strategy of approximately 24-hour delay in cardioversion shock timing decreased the incidence of ERAF, relative to a shock delivered within a few hours of AF onset. This observation has important mechanistic and therapeutic implications.     

Effect of verapamil on prevention of atrial fibrillation in patients implanted with an implantable atrial defibrillator.

BACKGROUND: The role of verapamil in the prevention of atrial fibrillation (AF) in patients with recurrent AF is unknown. HYPOTHESIS: The aim of this study was to evaluate the effect of verapamil on the prevention of AF in patients implanted with an implantable atrial defibrillator (IAD). METHODS: The effects of verapamil (240 mg/day) on the total duration of AF, number of AF recurrences, and number of cardioversions were prospectively evaluated in a randomized, crossover fashion over an 8-week period in 11 patients (9 men, 2 women; mean age: 60 +/- 6 years) implanted with an IAD. RESULTS: Implantable atrial defibrillators successfully converted 13 of 14 (93%) spontaneous episodes of AF. There was no significant difference in the efficacy of cardioversion (86 vs. 100%, p = 0.8), the total duration of AF (173 +/- 198 vs. 270 +/- 241 h, p = 0.5), the number of AF episodes (8.5 +/- 9.0 vs. 9.3 +/- 10.2, p = 0.3), and the number of cardioversions (1.7 +/- 2.4 vs. 1.8 +/- 2.1 p = 0.7) with or without treatment with verapamil. CONCLUSIONS: The results of the present study suggest that treatment with verapamil has no significant effect on the prevention of AF in patients treated with an LAD.     

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35例次随访

目的报告35例植入型心律转复除颤器（ICD）的随访结果.方法对我院1998年5月至2004年4月植入的31例,另有4例更换ICD患者进行电话询问和门诊随访（3～70个月,平均36.5个月）,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 4例患者死亡.31例患者共发作持续性室性心动过速/心室颤动（VT/VF）725次（VT534次,占73.7%,VF191次,占26.3%）,其中719次（96.8%）治疗成功,6次（3.2%）失败.534次VT中,454次（85.5%）经抗心动过速起搏（ATP）终止,80次（14.5%）经低能量复律（CV）终止.191次VF中,185次（96.9%）经高能量除颤（DF）终止,1例患者无效放电6次.3例患者发生误放电7次.结论 ICD疗效肯定,须密切随访,及时调整工作参数;应高度重视ICD患者的心理治疗.     

Predictors of new onset atrial fibrillation in patients with heart failure

Introduction

Stroke associated with atrial fibrillation (AF) is more frequent in heart failure. It is unknown what variables predict future AF in these patients and how AF might evolve over time. We investigated this in patients with implantable cardiac defibrillators (ICD) where AF detection is optimal.

Methods

Single centre, retrospective, observational cohort study. All ischaemic cardiomyopathy patients with dual chamber, primary prevention ICD implants between Aug 2003 and Dec 2009 were screened and included if at implant, they had no known AF history. Nine variables were analysed. AF was defined as any atrial tachyarrhythmia ≥ 180 bpm and ≥ 30 s. Multivariable, binary logistic regression models were built by adding variables significant in the univariate models. Variables were retained in the final multivariate models if p < 0.05.

Results

n = 197 met the inclusion criteria (85.8% male, median age: 66.8 years). After median follow-up for 2.8 years, 44.2% developed AF. After univariate analysis, the baseline variables associated with AF after implant were age, NYHA class and renal impairment (RI, defined eGFR < 60 ml/min/1.73 m²) (p < 0.05). After multivariable analysis, the only variable which was associated with AF was RI (HR: 2.04 (CI: 1.10–3.79)). Two baseline variables were independently associated with all-cause mortality: RI (HR: 2.42 (1.14–5.12)) and non-white ethnicity.

Conclusion

RI at time of implant was independently associated with both future AF and all-cause mortality during long-term follow-up. RI was a stronger predictor of AF than age. Those patients with heart failure and RI should be regularly screened for asymptomatic AF, regardless of age, to ensure that stroke prophylaxis may be initiated.