埋藏式心脏转复除颤器安置的临床经验

总结非开胸经锁骨下静脉穿刺安置埋藏式心脏转复除颤器 (ICD)的手术方法、除颤阈值 (DFT)测定及ICD工作参数设置等临床经验。 10例患者 ,6例有反复晕厥病史。 2例晕厥时心电图证实为心室颤动 (简称室颤 ) ,体外电除颤成功 ,另 8例心内电生理均诱发出持续性室性心动过速或室颤。其中冠心病 8例 (1例合并Brugada综合征 ) ,扩张性心肌病 1例 ,原发性室颤 1例。 5例术前口服胺碘酮治疗。结果 :全部经锁骨下静脉置入ICD ,术中所有患者成功诱发室颤 ,并一次电击成功。手术时间 92± 2 7min。DFT≤ 2 0J,电击阻抗 4 1.2± 15 .3Ω ,R波高度 16 .3± 6 .6mV ,无手术并发症。结论 :经锁骨下静脉置入ICD方法简单 ,安全可靠 ;术前口服适量胺碘酮对术中诱发室颤无影响。

Clinical Experience of Transvenous Implantable Cardioverter Defibrillator

To summarize the technical experience of the implantation of implantable cardioverter defibrillator(ICD) by a subclavicular puncture approach ,clinical data of the implantation of ICD, the induction of ventricular fibrillat ion, the detection of defibrillation threshold(DFT), and the programming of the parameters of ICD were analyzed. Results: ICD was successfully implanted by the subclavicular puncture approach i n ten patients,6 cases had a history of frequent syncope.Clinical documented ven tricular fibrillation was noted by ECG during syncope occurred in 2 patients and sustained ventricular tachycardia or fibrillation was induced in the other 8 ca ses. 8 of them suffered from coronary artery disease(one patient combining of Brugada s yndrome); One patient suffered from dilated cardiomyopathy; The other one was primary ventricu lar fibrillation. 5 of 10 patients took aminodarone.All patients were successful induced ventricular fibrillation and were successful defibrillated. The average time for the operat ion was 92±27 minutes. DFT≤20 J, shock path impedance 41.2±15.3 ohms, the amplitude of R wave was 16.3±6.6mV. T here were no complication in all patients. Conclusion:Implantation of ICD by the subclavicula r puncture approach is simple and reliable. Oral aminodarone before ICD implanted might not effect inducing ventricular fibrillation during procedure.