埋藏式自动复律除颤器干预室性心动过速或心室颤动患者预后的前瞻性研究

目的 探讨埋藏式自动复律除颤器(ICD)改善室性心动过速/心室颤动(VT/VF)患者预后的确切疗效,评价ICD与抗心律失常药物的优劣和ICD在中国的最佳适应人群;总结ICD患者的随访方法学,为ICD在中国的进一步推广提供科学依据.方法 99例有Ⅰ类ICD适应证的患者中,27例置入ICD(ICD组),另72例未接受ICD(非ICD组);两组患者除了ICD组晕厥、心肺复苏及确诊的VF多于非ICD组外,其余基础病、左室射血分数、心功能、心律失常等临床特征相似,并接受相同的基础治疗.比较两组人选后第3、6个月及第12、15个月累计病死率及心脏事件发生率.结果 在研究观察时间分别达3、6、12、15个月时,ICD组累计病死率和心脏事件发生率明显低于非ICD组.ICD组死亡为零,而非ICD组病死率为20.8%.结论 ICD可降低心脏性猝死高危人群心脏事件发生率,显著提高患者的生存率和生活质量;确保ICD高效、安全、经济的关键是:掌握适应证,优化置入和随访过程,合理选用辅助治疗.

The prospective study on the prognosis in patients with ventricular tachycardia or fibrillation treated with implantable automatic cardiovertor defibrillator

Objective To explore the effect of implantable automatic cardiovertor defibrillator (ICD)on improvement of the prognosis of patients with ventricular tachycardia or fibrillation(VT/VF).To compare the advantages and disadvantages of ICD with antiarrhythmic drug, to select the best indication of ICD and review the protocal of the following-up of ICD patients,and present scientific evidence for the morebroad popularization who needs ICD in China.Methods In 99 selected patients who had the indication of class Ⅰ,27 patients were treated by ICD(ICD group),and 72 patients were not(non-ICD group).Patients in the two groups had the similar basic clinical characteristics.The incidence of syncope, CPR, and VF in ICD group were more common than those in non-ICD group.Patients in the two groups received same basic therapy.The total mortality rate and the incidence of cardiac events in two groups were compared in 3 months, 6 months, 12 months and 15 months.Results The total mortality rate and the incidence of cardiac events in ICD group were significantly lower than those in non-ICD group in the follow-up period.The mortality rate in ICD group is 0,and the mortality rate in non-ICD group is 20.8%.Conclusions (1)ICD treatment can decrease the incidence of cardiac events of patients with high risk of sudden cardiac death (SCD),and improve their survival.(2)The key measures to insure the efficacy,safety,and cost-effectiveness of ICD treatment is:to select the patients correctly,to optimize the implanting process and the follow-up,and use rational assistant therapy.