恶性室性心律失常埋藏式心脏复律除颤器与药物治疗的对比研究

观察埋藏式心脏复律除颤器 (ICD)与药物对恶性室性心律失常的治疗效果 ,探讨其对心源性猝死的预防。94例患者 ,均有室性心动过速 (简称室速 )和 /或心室颤动等恶性室性心律失常发作史 ,其中冠心病 68例、原发性扩张型心肌病 2 6例。根据电生理心室程序刺激结果将患者分为药物治疗组 (A组 )、ICD组 (B组 )和慢频率室速药物治疗组 (C组 )。分别给予胺碘酮和 /或阿替洛尔药物治疗和ICD治疗。观察随访 1 ,2 ,5年的总生存率 ,不同左室射血分数 (EF)值亚组的生存率和心律失常性死亡的发生率。结果显示 ,随访 5年的总生存率C组明显低于A、B两组(P <0 .0 5 ) ,B组的低EF(≤ 0 .40 )值亚组的 5年生存率明显高于A、C两组的低EF值亚组 (P <0 .0 5 )。B组随访期间无心律失常死亡者 ,其心律失常性死亡事件的发生率明显低于A、C两组 (P <0 .0 5 )。结论 :ICD对于合并有恶性室性心律失常的心脏病人预防猝死的总体效果优于 β 阻断剂和胺碘酮等药物治疗。这尤其见于长期随访 (≥ 5年 )和伴有心功能不全 (EF值≤ 0 .40 )的病人。对于有过恶性室性心律失常发作史的患者 ,若心电生理检查不能诱发室速 ,在没有条件安装ICD时 ,胺碘酮与 β 阻断剂联合应用仍可在一定程度上减少心源性猝死的发生。

Comparative Research of the Treatment of Malignant Ventricular Arrhythmia With Implantable Defibrillator and Antiarrhythmic Drugs

To observe the effects of implantable cardioverter defibrillator (ICD) and antiarrhythmic on malignant ventricular arrhythmia, discuss the prevention of sudden cardiac death, 94 patients had the history of ventricular tachycardia and / or ventricular fibrillation or other malignant ventricular arrhythmia, including 68 patients of coronary heart disease and 26 patients of primary dilated cardiomyopathy. They were assigned to antiarrhythmic therapy group ( Group A ), ICD group ( Group B ) and low frequency ventricular tachycardia with drug therapy group ( Group C), according to the electrophysiological results of programmatic ventricular stimulation. Amiodarone and / or atenolol therapy and ICD therapy were given them respectively. Follow up the 1, 2, 5 year(s) survival rate and mortality of sudden cardiac death of each group, survival rate of sub group with different left ventricular ejection fraction(EF) value. The 5 year survival rate of Group C is lower than Group A and B ( P < 0.05 ). The 5 year survival rate of sub group with low EF ( EF≤0. 40 ) of Group B was significantly higher than those of Group A and C. No sudden cardiac death occurred in Group B during the period of follow up, the mortality of sudden cardiac death was lower than those of Group A and C ( P < 0.05 ). Conclusions : ICD is better than β blockers and amiodarone on the preventive effect of sudden cardiac death to the patients with heart disease complicating malignant ventricular arrhythmia, especially in the long term follow up patients ( ≥ 5 years ) and in the patients with cardiac deficiency ( EF ≤ 0.40 ). Amiodarone and β blockers can reduce the occurrence of sudden cardiac death if ICD has not been implanted in the patients with a history of malignant ventricular arrhythmia, nonrepetitive in electrophysiological examination.