植入型心律转复除颤器治疗室性心动过速

多中心研究表明植入型心律转复除颤器 (ｉｍｐｌａｎｔａｂｌｅｃａｒｄｉｏｖｅｒｔｅｒｄｅｆｉｂｒｉｌｌａｔｏｒ ,ＩＣＤ)对防治室性心动过速及室颤所致的猝死有明显疗效 ,ＩＣＤ在临床上主要是应用于有致命性室性心律失常的患者 ,已成为治疗恶性室性心律失常的重要手段 ,最终目的是降低猝死率。长期随访的研究已证实 ,植入ＩＣＤ后 ,每年的猝死发生率为 1%～ 2 % ,远远低于未植入的 15 %～2 5 %。我院 2 0 0 1年 5月开展ＩＣＤ治疗导致反复晕厥的室性心动过速 1例 ,报告如下。1　资料与方法1 1　临床资料　患者女 ,83岁 ,因发作性胸痛…     

植入型心律转复除颤器植入患者出院3个月随访期护理

目的 讨论植入型心律转复除颤器（ICD）植入患者出院后于3个月随访期的护理。方法 通过门诊复诊，家庭访问，电话咨询方式收集已出院ICD植入患者资料进行分析。结果 随访例，普遍存在心理紧张，焦虑与不适应，并且发现心理改变主要与ICD放电有关。结论 为出院后ICD植入患者提供恰当的护理指导能有效消除患者担忧，稳定情绪，适应日常生活，提高生活质量。     

植入型心律转复除颤器治疗室速、室颤的护理

目的:总结植入型心律转复除颤器安置术的护理要点及术后随访情况。方法:对4例心律转复除颤器植入患者进行了护理及随访。结果:术后有1例患者出现心律失常“风暴,”1例患者出现误放电,随访11~49个月,4例均存活。结论:术前及术后重视患者的心理护理,术后密切观察病情,积极预防心律失常“风暴”、误放电现象,并做好健康教育,是心律转复除颤器手术成功的重要护理措施。     

植入型心律转复除颤器患者的心理分析及护理对策

探讨植入型心律转复除颤器(ICD)的患者由于电转复治疗出现恐惧、精神抑郁、焦虑、性功能减退等症状存在的心理问题，分析其相关因素并提出护理对策，加强对患者的心理教育，加强相关知识宣教，沟通信息，争取社会支持做好出院指导，有效提高患者的生活质量。     

安置植入型心律转复除颤器1例护理体会

2007年2月，我们为1例患者安置植入型心律转复除颤器（ICD），经精心护理，效果满意。现将护理体会报告如下。     

经静脉植入心律转复除颤器病人的护理

在冠心病、心肌梗死死亡病人中 ,2 /3死于心脏性猝死。而心脏性猝死大部分是由心律失常引起 ,以室速、室颤引起者占82 %以上。较多的研究资料证实 :植入型心律转复除颤器 (ICD)的应用大大降低了心脏性猝死的发生率 ,因其采用静脉导线系统 ,简化了手术程序 ,缩短了病人住院时间 [1 ,2 ] ,给病人带来了益处。通过对 4例行 ICD治疗病人的护理 ,作者认为 ,良好的术前准备、术中测试起搏器相关参数、术后及时的观察和处理 ,对ICD的成功放置起到了至关重要的作用。1　临床资料本组 4例 ,系 1997年— 2 0 0 0年住院病人 ,均为男性 ,年龄39岁～ …     

12例植入型心律转复除颤器围手术期的护理

总结12例恶性心律失常患者植入心律转复除颤器(ICD)治疗的护理,重视患者术前宣教准备,术中积极配合,术后密切观察病情变化,积极预防各种并发症,是ICD手术成功的重要护理措施。     

植入型心律转复除颤器治疗恶性室性心律失常患者围手术期护理

心源性猝死大多由恶性室性心律失常（如室速、室颤）引起。植入型心律转复除颤器（implantahle cardioverter defibrillator,ICD）是一种能自动识别恶性室性心律失常并能在数秒内使之终止并转复为正常心律的体内除颤起搏装置,成为预防心源性猝死的有效手段。我院2006年12月～2009年3月共为20例患者植入ICD,均达到满意的效果。现将护理体会总结如下。     

植入型心律转复除颤器治疗老年恶性心律失常1例的护理

植入型心律转复除颤器（implantable cardioverter defibrillator，ICD）是目前预防心源性猝死最有效的措施。在植入ICD患者中有相当一部分患者伴有充血性心力衰竭，而双心室同步起搏可使这一部分患者心功能得到改善，并减少恶性心律失常的发生，从而减少ICD的放电次数，改善生活质量。我科2003年11月对1例高龄恶性心律失常的患者行植入型心律转复除颤器治疗，取得良好效果，现报道如下。     

植入型心律转复除颤器的临床应用及随访观察

目的 :观察我院 8例次植入型心律转复除颤器 (implantablecardioveterdefibrillatorICD)患者的临床疗效及随访情况。方法 :自 1996年 7月至 2 0 0 3年 9月 ,共有 7例患者 (其中 1例更换 1次 )在我院成功安装了ICD。 4例为扩张型心肌病 ,1例为长QT间期综合症 ,1例为多形性室性心     

Infections in Implantable Cardioverter Defibrillator Patients

Implantable cardioverter de;fibrillators fICDsj have been documented as an effective modality in reducing arrhythmic mortality. A serious complication associated with implantation of the device is infection. Few studies have addressed this issue. Two hundred seven patients with refractory ventricular arrhythmias underwent 207 ICD implantations, and 56 subcutaneous generator changes at our institution. Eight patients developed wound infections, four following ICD implantation (4 out of 207 or 1.9%), and four following a generator change (4 out of 56 or 7.1%). Wound cultures most commonly revealed Staphylococcus aurous and Staphylococcus epidermidis. Infections treated with antibiotics alone, or with only generator removal, frequently recurred (four out of five attempts). There were no recurrences following total patch/lead and generator system removal. In jive patients, the same generator unit was successfully emplaned following ethylene oxide sterilization without infection recurrence. We conclude that treatment of device-associated infection generally requires total generator and patch/lead system removal, and that generator units can be successfully reimplanted yielding substantial cost savings.     

Infection of Implantable Cardioverter Defibrillator Systems: A Preventable Complication?

In a consecutive series of 164 patients undergoing primary implantation of an impJantable cardioverter defibrillator (ICD), two patients died in the hospital (1.2%) and early system infection developed in one patient requiring expJantation of the device (0.61%). Late infection developed in one additional patient (0.61%) 7 months after transvenous ICD implantation, and was thought to be due to a recent intravascular catheterization. Symptomatic generator pocket hematomas developed in three patients, two of which were treated by simple evacuation and one with temporary generator explantation and subsequent reimplantation of the unit in a new pocket. No infection developed in these three patients during follow-up. Generator erosion without obvious system infection developed in a fourth patient. Guidelines for the prevention of infection in ICD systems are presented.     

AutoCapture with Dual-Coil Leads of Implantable Cardioverter Defibrillator

AutoCapture™ (AC) can confirm ventricular capture with true bipolar single coil leads of implantable cardioverter defibrillators (ICD). The compatibility of AC with a new, true bipolar, dual-coil ICD lead needed to be evaluated. This multicenter study enrolled 46 patients (69 ± 10 years, 37 men) undergoing ICD implantation. All patients received a true bipolar, dual-coil lead. Evoked response (ER) sensitivity and AC threshold tests were performed using a pulse generator with the AC algorithm. Mean capture threshold was 0.85 ± 0.67 V, pacing impedance 612 ± 225 Ω, R wave amplitude 13.85 ± 6.17 mV, and defibrillation threshold 14.4 ± 5.1 J. AC was recommended in 45 patients (97.8%) with ER and polarization values of 14.86 ± 7.32 mV and 0.87 ± 0.69 mV, respectively. The AC algorithm was highly compatible with true bipolar, dual-coil ICD leads. An AC algorithm specifically designed for an ICD may improve the generator longevity. Further examination of AC compatibility with other leads is warranted.     

Initial Experience with Transvenous Implantable Cardioverter Defibrillator Lead Systems: Operative Morbidity and Mortality

Introduction of non-thoracotomy lead systems™ (Medtronic, Inc.) for the implantable cardioverter defibrillator (ICD) has expanded the indications for use of this mode of therapy. Patients previously considered "too ill" to undergo a thoracotomy as well as patients who are at a high risk for developing sudden death but without previous cardiac arrest, are now considered candidates. The initial experience with the non-thoracotomy lead system at our institution was analyzed for morbidity and mortality. Thirty-four patients underwent attempted intravascular lead implantation, with 30 having initial successful implantation (88.2%). There were 23 males; average ejection fraction (EF) was 38.6%. Three patients developed pulmonary edema and low output immediately after the procedure. Three patients developed electromechanical dissociation during defibrillation threshold testing. A prolonged testing time for the non-thoracotomy lead system was noted when compared to the thoracotomy system (57.39 vs 32.30 min; P < 0.0000). There were more intraoperative morbidities with the non-thoracotomy leads than with the thoracotomy system. There were no perioperative deaths. The potential consequences of prolonged anesthesia time and extensive defibrillation threshold testing should be considered when choosing the route of ICD implant, the type of anesthesia, and the intraoperative testing protocol for each patient.     

The Value of DDD Pacing in Patients with an Implantable Cardioverter Defibrillator

Although the beneficial effects of DDD pacing are well known, currently available ICDs provide only fixed rate ventricular antibradycardia pacing. In a consecutive series of 139 patients with ICDs, we have analyzed the need for antibradycardia pacing and the indications for DDD pacing. We also report our initial experience with the Defender 9001 (ELA Medical, France) DDD-ICD. Out of 139 patients, 25 (18%) were in need of antibradycardia pacing. Ten patients already had a pacemaker at the time of ICD implantation and ten other patients had a conventional pacemaker indication at that time. Five patients became pacemaker dependent during a follow-up of 20 ± 8 months. The disorders necessitating pacemaker therapy were high degree AV conduction disturbances in 72%, sick sinus syndrome in 12%, and AF with a slow ventricular response in 16% of patients. Based upon current indications, DDD pacing was indicated in 20 (80%) of 25 patients. The Defender 9001 DDD-ICD (ELA Medical) was used in two patients with ischemic cardiomyopathy and pacemaker syndrome with VVI pacing. Cardiac output during DDD pacing increased by 36% in one patient with an increase in VO₂ max during exercise of 29%. The other patient showed an increase in cardiac output of 50% with DDD pacing, and, while unable to exercise with VVI pacing, had a VO_2max of 24 mL/kg per minute during DDD pacing. Up to 18% of our ICD patients are in need of antibradycardia pacing. Of these pacemaker dependent patients, 80% have an indication for DDD pacing. Our first clinical experience with a DDD-ICD confirms the hemodynamic benefit of AV synchronous pacing in ICD patients with pacemaker syndrome.     

Modified Magnet Test for a Reversed Automatic Implantable Cardioverter Defibrillator

We present the case of a 55-year-old man with atrial septal defect and cardiomyopathy who underwent implantation of an automatic cardioverter defibrillator (AICD) for ventricular tachycardia resulting in collapse. This case demonstrates multiple unusual complications related to AICD, including rotation of the pulse generator unit about its long axis requiring a "left-handed" magnet test to determine the appropriate counts.     

Implantable Cardioverter Defibrillator Proarrhythmia: Case Report and Review of the Literature

A 31-year-old man who received an automatic cardioverter defibrillator subsequently underwent exercise testing. During exercise, a sinus tachycardia resulted above his device detect rate prompting two shocks, the second of which produced an unstable polymorphous ventricular tachycardia. In this article, we review the literature on automatic cardioverter defibrillator-induced ventricular tachyarrhythmias as well as the management of exercise testing in patients with these devices.