植入型心律转复除颤器在心脏性猝死一级预防中的应用

目的随访观察植入型心律转复除颤器（ICD）／心室再同步心律转复除颤器（CRT．D）在中国单中心心脏性猝死（SCD）高危患者一级预防中的临床应用。方法入选2009年1月至2011年12月入住浙江大学医学院附属第一医院心内科符合一级预防适应证并植入ICD／CRT．D的患者共80例，其中33例植入单腔／双腔ICD，47例植入CRT．D。基础病因主要为扩张性心肌病（55．0％）和冠状动脉性心脏病（27．5％）。植入ICD／CRT．D后第1个月末和第3个月末各随访1次，以后每6个月随访1次，若患者发生电击等ICD治疗事件，则即时进行检查。结果80例患者平均随访（23±7）个月，非计划性再入院11例（13．7％），死亡4例（5．0％）。记录ICD治疗事件共38次，其中有26次（68．4％）为ICD识别持续性VT／VF发作而进行的适当治疗，12次（31．6％）为由于心房颤动而进行的不适当治疗事件。结论ICD，CRT—D能在短时间内对发生恶性快速性心律失常的患者进行识别及实施治疗，在SCD一级预防中疗效明确，可使SCD的高危患者获益。

Implantable cardioverter defibrillator therapy for primary prevention of sudden cardiac death: a single center experience

Objective To evaluate the clinical application of implantable cardioverter defibrillator （ICD）/cardiac resynchronization therapy-defibrillator （CRT-D） for primary prevention in sudden cardiac death （SCD） high-risk Chinese patients. Methods Eighty patients treated with I CD / CRT-D implantation for primary prevention of SCD in our unit between 2009 and 2011 were enrolled in the study. Single-chamber or dual-chamber ICDs were implanted in 33 cases and CRT-D in 47 cases. Of the 80 cases, 44 （55.0%） had non-ischemic cardiomyopathy and 22 （27.5%） had ischemic cardiomyopathy. All the patients were followed up at one and three months after implantation, and every six months thereafter or when prompted by an ICD event. Results During an average follow-up of 23 ± 7 months, 11 （13.7%） patients had unplanned readmissions and 4 （5.0%） died. Thirty-eight ICD therapy events were recorded, including 26 appropriate ICD therapies and 12 inappropriate therapies, of the later were due to atrial fibrillation. Conclusions ICD/CRT-D for primary prevention of SCD may recognize malignant rapid arrhythmia in a short time so that the patients can be treated timely. Therefore, it can reduce the sudden cardiac death rate in high-risk patients.