经皮冠状动脉介入治疗防治冠心病无心肌梗死患者的电风暴

目的针对冠心病无心肌梗死者的电风暴,探讨经皮冠状动脉介入治疗的防治效果和安全性。方法选择以电风暴为主要表现的冠心病患者,按标准方法行冠状动脉造影和支架置入术,术后定期动态心电图检查。结果6例患者(男5例,女1例),平均年龄(49.5±9.1)岁。1例运动时室性心动过速(室速)/心室颤动(室颤),2例晨起反复晕厥,动态心电图示多形室速/室颤,3例胸痛、胸闷,反复心脏骤停急诊入院,心电图示ST抬高和反复室颤,电击除颤后ST段恢复正常。6例患者术前晕厥/室颤发作,平均(16.5±5.3)次,共置入8枚冠状动脉支架,5枚为金属裸支架,3枚为药物洗脱支架,全部患者残余狭窄均≤10%,靶血管血流达TIMI3级。置入支架解除狭窄后,电风暴与STT改变消失,症状缓解。最长随访6.5年,最短随访4个月,平均(47.7±30.7)个月,4例均无不适和心律失常,1例2年后胸闷,动态心电图示心动过缓,行冠状动脉造影未见异常。1例出院后6年内无特殊不适,间断服药,置入心脏自动转复除颤器仅有1次剧烈运动窦性心动过速触发的不恰当电击。结论对于冠心病无心肌梗死者,置入冠状动脉支架解除狭窄,可消除缺血性电风暴的病理基础,有效防治心脏性猝死。

Efficacy and safety of the coronary intervention therapy to prevent electrical storm in patients with coronary artery disease but without myocardial infarction

OBJECTIVE: To study the efficacy and safety of the coronary interventional therapy to prevent electrical storm (ES) in patients with coronary artery diseases (CAD) but without myocardial infarction or ischemic cardiomyopathy. METHODS: Coronary angiography and stent implantation were performed in CAD patients with ES as major symptom, according to the standardized methods. Holter Electrocardiography was recorded regularly during follow-up. RESULTS: Six patients, five male and one female, with mean age of 49.5 +/- 9.1 year-old, were hospitalized. In 2 patients with repetitive syncope, multiple episodes of ventricular tachycardia and/or ventricular fibrillation (VF) were documented by Holter recording. One patient developed VF during exercise test. Three patients experienced chest pain and multiple episodes of cardiac arrest. Before procedure, averaged 16.5 +/- 5.3 episodes of syncope or VF were documented in 6 patients. Coronary angiography revealed severe one or multi-vessel diseases. Total 8 stents, including 3 drug-eluting stents, were implanted in 6 patients. Symptom, ST-T changes and ES disappeared after coronary stenting. During 4 month to 6.5 year follow-up (mean 47.7 +/- 30.7 months), ES was not documented, no appropriated shock occurred in patients with implantable defibrillator for 6.5 years. CONCLUSION: In CAD patients without myocardial infarction, coronary stenting can relieve the ischemic substrate of ES, hence prevents sudden death effectively.