埋藏式心脏转复除颤器在心脏性猝死一级预防方面的应用

对于心脏性猝死(SCD)的高危人群——发生过心肌梗死或未发生过心肌梗死的心力衰竭患者,埋藏式心脏转复除颤器(ICD)治疗均能有效降低死亡率;对于存在SCD高危因素的肥厚型心肌病患者及Brudaga综合征患者ICD治疗同样能有效地降低死亡率;对于同时符合ICD和心脏再同步化治疗(CRT)适应证的患者CRT-D治疗是最佳治疗方案。在我国ICD的二级预防尚难实现,一级预防的实施将面临更艰难的现实。     

埋藏式心律转复除颤器在心脏性猝死的一级预防的应用

心脏性猝死(SCD)是心血管病患者的主要死亡原因,如何进行一级预防至关重要,本文分析了慢性心力衰竭患者室性心律失常的诱发因素,介绍了应用埋藏式心律转复除颤器(ICD)在心脏性猝死一级预防的临床试验,以及ICD应用的适应证。     

埋藏式心脏转复除颤器不恰当治疗的分析及处理

目的总结分析埋藏式心脏转复除颤器(ICD)不恰当识别与治疗的原因及处理对策。方法对34例植入ICD患者记录的相关信息进行分析、归类,统计ICD记录的各个事件的次数、ICD不恰当识别及治疗的原因。结果随访20.07±21.66(1～71)个月,ICD记录室性心律失常事件共289次,7例接受不恰当的识别和治疗,ICD电击治疗83次,不恰当电击治疗21次(其中因心房颤动所致6次,阵发性室上性心动过速12次,肌电干扰3次),占电击治疗总数的25.30%(21/83),通过调整ICD的相关参数、应用抗心律失常药物、行射频消融手术,对不同的病例进行个体化处理。结论室上性快速心律失常是ICD不恰当电击治疗的主要原因,对于ICD植入患者,应进行个体化的程控和治疗,以减少不恰当识别及治疗事件的发生。     

心脏性猝死一级预防与二级预防患者植入埋藏式心脏转复除颤器术后的随访观察

目的对比心脏性猝死(SCD)一级和二级预防患者植入埋藏式心脏转复除颤器(ICD)术后生存与适当治疗的情况。方法连续入选于本院行ICD或带除颤功能的心脏再同步治疗(CRT-D)植入术的患者,随访记录患者的生存情况、ICD保存的室性心律失常与治疗数据,对比一级预防与二级预防组间生存与ICD适当治疗,并寻找ICD术后生存和ICD适当治疗的预测因素。结果入选124例患者,一级预防组63例,二级预防组61例,中位随访时间300天。共有12例患者死亡(9.6%),其中一级预防组7例(11.1%),二级预防组5例(8.2%),组间生存曲线无统计学差异(P=0.095)。术前log(NT-proBNP)是术后生存的唯一独立预测因素(HR=8.81,P=0.047)。共有24例患者接受过ICD适当治疗(19.4%),组间术后ICD适当治疗曲线存在显著差异(P=0.014)。QRS波时限(QRSd)是术后ICD适当治疗的独立预测因素(HR=1.24,P=0.020)。QRSd≥120 ms的患者中二级预防组患者更早接受ICD适当治疗(P=0.027),QRSd<120 ms的患者中组间首次ICD适当治疗时间无差异(P=0.242)。结论因SCD一级预防与二级预防植入ICD患者在术后生存无显著差异;二级预防较一级预防患者更早接受ICD适当治疗,这种差异主要归因于术前QRSd≥120 ms的患者。     

皮下埋藏式心脏转复除颤器技术研究进展

皮下埋藏式心脏转复除颤器(ICD)(S-ICD)技术是预防心源性猝死(SCD)的新尝试,避免了传统静脉ICD的导线并发症,适用于导线并发症发生率高、无起搏指征、预期生存时间长的年轻患者。众多临床研究证实了S-ICD在治疗SCD中的有效性、安全性。S-ICD系统主要由脉冲发生器、皮下电极、体外程控仪构成。S-ICD存在延迟放电、不恰当放电、高能放电、无起搏功能、兼容性等尚存争议的问题。S-ICD在一定适应证范围内有潜在大的应用前景。     

埋藏式心脏转复除颤器一级预防患者恶性室性心律失常的发生及影响因素分析

目的 分析比较埋藏式心脏转复除颤器(ICD)一级预防和二级预防患者每年恶性室性心律失常发生率的异同,明确ICD一级预防患者发生恶性室性心律失常的可能预测因素.方法 连续入选2010年1月至2016年12月于大连医科大学附属第一医院行ICD治疗的患者,随访至少4年,比较一级预防与二级预防组术后每年累积恶性室性心律失常的发...     

埋藏式心脏转复除颤器治疗患者的心房颤动回顾性分析

回顾性分析埋藏式心脏转复除颤器(ICD)治疗患者中心房颤动(AF)的发生率,评价AF对ICD治疗患者再次住院、不适当放电治疗和总死亡率的影响。182例ICD置入患者,随访48±17个月,用存活率回归分析等相关统计方法,对AF组和窦律(SR)组再住院率、不适当放电治疗和总死亡率等进行比较。结果:两组在室性心律失常再发生率和再住院率上无明显差异(P>0.05)。存活率分析,AF组患者较SR组患者低(P=0.038)。ICD治疗患者,新的AF发生率为8.43%。在AF组中,ICD治疗前有AF病史的患者其不适当放电治疗发生率为25%,而新出现AF病史的患者,不适当放电治疗发生率为64.3%(P<0.05)。结论:ICD治疗后,新发现的AF患者有更高的不适当放电治疗危险。有AF病史的患者,3年存活率比一直为窦性节律的患者低。     

埋藏式心脏转复除颤器治疗的心理问题

安置了埋藏式心脏转复除颤器(ICD)的患者出现心理问题的发生率国外报道为30%～50%。统计国内文献其发生率平均为37.8%,电击产生的心理问题最多,占55.5%,ICD本身产生的占35.6%。心理问题的临床表现及后果有①焦虑、抑郁;②行为对抗和自杀;③性功能障碍;④安置器械一侧肢体强迫制动和肢体乏力;⑤频繁室性心动过速发作。产生的原因有①生物学原因:基础心脏病的发作和加重;②认识因素:对ICD植入适应不良和对电击产生恐惧;③社会性因素:社会支持系统发生变化。处理策略有①加强基础心脏病和心律失常的治疗;②调整ICD参数,减少电击治疗;③心理咨询和心理治疗;④改善社会支持系统。     

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。     

全皮下埋藏式心脏转复除颤器

全皮下埋藏式心脏转复除颤器是近年来器械治疗的一大进展。因其无需静脉植入除颤导线,可避免静脉导线相关的一些并发症,但局限为没有起搏功能。     

植入型心律转复除颤器一级预防的费用-效果分析

过去十余年间,数项大规模随机对照试验证实植入型心律转复除颤器（ICD）可以改善左心室收缩功能不良导致的慢性心力衰竭患者的预后（一级预防）,ICD也因此在全世界范围内得到了广泛的应用.然而,ICD价格昂贵,而且在后期随访与更换中会产生大量费用,这些费用给患者家庭与社会带来的经济负担不容小觑.本文拟从费用-效果分析（cost-effectiveness analysis,CEA）的角度,对ICD做一经济评估.     

Recent primary prevention implantable cardioverter defibrillator trials

PURPOSE OF THE REVIEW: The aim of this article is to summarize the most relevant findings of recently published trials on prophylactic implantable cardioverter defibrillator therapy. RECENT FINDINGS: A number of important randomized clinical trials on the efficacy of prophylactic implantable cardioverter defibrillator therapy in patients deemed to be at high risk for ventricular tachyarrhythmias have recently reported their results. Patients with chronic ischemic cardiomyopathy, a long history of heart failure, and an ejection fraction of 0.30 or below benefit from preventive device therapy and are thus candidates for prophylactic defibrillator implantation. For this purpose, a single chamber device appears to be appropriate since there have been no prospective studies showing convincing clinical benefit by adding an atrial lead. Prophylactic implantable cardioverter defibrillator therapy should not be used in patients with recent myocardial infarction. There is convincing evidence from one trial that benefit from the defibrillator in coronary patients accrue after a considerable time has elapsed from the most recent infarct, presumably at least 6 months or perhaps longer. Finally, in patients with chronic dilated non-ischemic cardiomyopathy and a left ventricular ejection fraction of 0.35 or below, there is also benefit from prophylactic implantable cardioverter defibrillator therapy. SUMMARY: Taken together, these trials allow an evidence-based approach to primary prevention of sudden cardiac death in patients with both ischemic and non-ischemic cardiomyopathy.     

Predictors of all-cause mortality for patients with chronic Chagas' heart disease receiving implantable cardioverter defibrillator therapy

Background: Implantable Cardioverter Defibrillators (ICD) have sporadically been used in the treatment of either Sustained Ventricular Tachycardia (VT) or Ventricular Fibrillation (VF) in Chagas' disease patients. This study aimed at determining predictors of all-cause mortality for Chagas' disease patients receiving ICD therapy.
Methods and Results: Ninety consecutive patients were entered the study. Mean left ventricular ejection fraction was 47 ± 13%. Twenty-five (28%) patients had no left ventricular systolic dysfunction. After device implantation, all patients were given amiodarone (mean daily dose = 331, 1 ± 153,3 mg), whereas a B-Blocking agent was given to 37 (40%) out of 90 patients.
Results: A total of 4,274 arrhythmias were observed on stored electrogram in 64 (71%) out of 90 patients during the study period; SVT was observed in 45 out of 64 (70%) patients, and VF in 19 (30%) out of 64 patients. Twenty-six (29%) out of 90 patients had no arrhythmia. Fifty-eight (64%) out of 90 patients received appropriate shock, whereas Antitachycardia Pacing was delivered to 58 (64%) out of 90 patients. There were 31 (34%) deaths during the study period. Five patients were lost to follow up. Sudden cardiac death affected 2 (7%) out of 26 patients, whereas pump failure death was detected in the remaining 24 (93%) patients. Number of shocks per patient per 30 days was the only independent predictor of mortality.
Conclusion: Number of shocks per patient per 30 days predicts outcome in Chagas' disease patients treated with ICD.     

Indications for implantable cardioverter defibrillator use for primary prevention of sudden cardiac death

The implantable cardioverter defibrillator (ICD) is used for primary and secondary prophylaxis of sudden cardiac death in high-risk patients. Although several trials have demonstrated the superiority of ICD over standard medical therapy or antiarrhythmic medication in this population, a few trials have not shown survival benefit. This review examines the major ICD trials that provide the basis for current therapy in this rapidly changing and very important area of cardiology.     

The implantable cardioverter defibrillator

Implantable cardioverter defibrillators (ICDs) have evolved from the treatment of last resort to the gold standard therapy for patients at high risk for ventricular tachyarrhythmias. High-risk patients include those who have survived life-threatening arrhythmias, and individuals with cardiac diseases who are at risk for such arrhythmias, but are symptomless. Use of an ICD will affect the patient's quality of life. Some drugs can substantially affect defibrillator function and efficacy, and possible drug-device interactions should be considered. Patients with ICDs may encounter cell phones, antitheft detectors, and many other sources of potential electromagnetic Interference. In addition to treating ventricular tachyarrhythmias, new defibrillators provide full featured dual chamber pacing, and could treat atrial arrhythmias, and congestive heart failure by means of biventricular pacing.     

植入型心律转复除颤器在一级预防心力衰竭患者中的应用

目的 观察左心室射血分数（LVEF）≤0.35心力衰竭患者的预后,评价植入型心律转复除颤器（ICD）作为心脏性猝死（SCD）一级预防的疗效.方法 回顾性分析2007年1月1日至2009年12月31日在北京协和医院心内科住院LVEF≤0.35且否认既往心肺复苏、晕厥和持续室性心动过速（室速）或心室颤动（室颤）心力衰竭患者,收集住院期间临床资料和实验室检查数据,以电话随访为主,主要观察终点为全因死亡,次要观察终点为全因死亡或首次心脏性再住院的联合终点.使用Kaplan-Meier法进行生存分析.结果 共83例患者入选,5例（6.4％）失访,78例完成了随访,包括ICD组20例和对照组58例.经过中位21.5（2.0～41.0）个月随访,共19例（24.4％）死亡.总体1、2、3年全因死亡率分别为16.5％、26.4％、35.0％.ICD组和对照组1年死亡率分别为10.5％和18.3％ （P=0.525,Log-rank检验）,ICD组死亡率降低了42.6％;18个月死亡率分别为10.5％和24.8％（P=0.340,Logrank检验）,ICD组死亡率降低了57.7％.全因死亡或心脏性再住院联合终点事件的1、2、3年发生率分别为40.1％、56.0％、76.0％.ICD组和对照组1年联合终点事件发生率分别为26.5％和44.1％（P=0.203,Log-rank检验）,ICD组事件发生率降低了39.9％;18个月联合终点发生率分别为26.5％和54.6％（P=0.110,Log-rank检验）,ICD组事件发生率降低了51.5％.结论 LVEF≤0.35心力衰竭患者预后较差,ICD具有降低死亡率和心脏性再住院率的倾向性.需要进一步扩大样本量研究来证实.