植入型心律转复除颤器治疗冠心病伴室性心律失常疗效观察

目的 观察冠心病伴恶性室性心律失常患者植入心律转复除颤器(ICD)治疗后的长期预后.方法 23例冠心病患者,其中男性18例,女性15例,年龄(71.56±10.38)岁.心功能不良16例.22例行血运重建术(经皮冠状动脉介入术20例,冠状动脉搭桥术2例).术后发生晕厥9例,持续性室性心动过速(VT)发作22例,心室颤动(VF)发作5例.植入单腔ICD(VVI)15例,双腔ICD(DDDR)1例,三腔ICD(CRT-D)7例.随访时间平均为(33.37±25.39)个月.结果 (1)死亡2例,因急性心肌梗死和急性左心衰竭死亡各1例.(2)4例患者术后再次住院.原因:1例为心功能不良,3例为ICD多次放电住院.(3)13例(56.5%)发生持续性VT或VF事件.持续性VT发作434次,386次(98.6%)经抗心动过速起搏(ATP)治疗成功.FVT发作25次,ATP治疗FVT总的成功率为84.0%.(4)ICD电风暴3例.(5)ICD误识别及误治疗2例.结论 冠心病伴恶性室性心律失常患者血运重建后用ICD治疗,可防止由于心肌的慢性的瘢痕产生室性心律失常而导致猝死的风险.

Prognosis in patients with coronary heart disease and ventricular arrhythmias received implantable cardioverter defibrillators

Objective The purpose of this study was to observe long-term prognosis in patients with coronary heart disease(CHD) and fatal ventricular arrhythmias who underwent implantable cardioverter deilbrillators (ICD). Methods In 23 patients(age71.56 ± 10.38 years,18 male,16 cardiac insufficiency) ,ICD were implanted. Twenty patients received percutaneous coronary interventions(PCIs) ,2 patients received coronary artery bypass graft surgery(CABG). The patients suffered from syncope in 9, ventricular fibrillation (VF) in 5,sustained ventricular tachycardia(VT) in 22, of which 15patients received single-chamber ICDs (VVI), 1 received double-chamber ICDs(DDDR) ,and 7 received triple-chamber ICDs(CRT-D). The mean follow-up period was(33. 37 ±25.39)months. Results Two patients died for acute myocardial infarction or acute left heart failure respectively. Four patients accepted rehospitalization due to cardiac insufficiency, and electrical storm. During follow-up period, 13 patients (56. 5% )had sustained VT or VF events. Four-hundred and thirty-four sustained VT and 25 FVT episodes were recorded in all patients, majority of which were successfully terminated by antitachycardiac pacing. There were ICD electrical storms in 3 patients and inappropriate detection and thempies in 2 patients. Conclusions ICD therapies for patients with CHD and fatal ventricular arrhythmia after PCIs or CABG can prevent sudden death for VT( or VF)from myocardial chronic eicatricle.