植入型心律转复除颤器抗心动过速起搏治疗室性心动过速疗效评价

目的恶性室性心律失常（室性心动过速,心室颤动）是心脏性猝死的主要直接原因.而大部分患者先发生室性心动过速（室速）,继而蜕变为心室颤动（室颤）.研究表明,抗心动过速起搏（ATP）可有效终止室速.本文观察了172例植人植入型心律转复除颤器（ICD）的患者应用ATP终止室速的效果.方法172例植入ICD的患者,男性137例,女性35例,平均年龄52.8岁.103例患者术前有阿-斯综合征发作史,其中75例有电击除颤史.137例术前记录到室速或室颤心电图.植入ICD患者定期随访,随访时应用体外程控仪调出ICD储存记录,分析ICD治疗中ATP治疗室速的效果.结果在平均随访37个月中,ICD共记录室速l 789阵.其中,316阵为短阵室速,在ICD治疗前自行终止;1 473阵室速接受了ICD有效治疗.其中ATP治疗成功981阵（成功率66.6%）,余492阵室速由低能量转复终止.在981阵ATP治疗成功的事件中,ICD第一次发放ATP成功终止室速513阵（成功率52.3%）.结论ICD抗室速起搏功能可有效终止大多数室速,对于植入ICD前有明确室速史的患者,ICD治疗应尽量先采用ATP治疗,以减少ICD放电,延长ICD使用寿命及避免电击时的痛苦,即所谓的＂无痛性ICD治疗＂.

Evaluation of the efficacy of antitachycardia pacing on ventricular tachycardia in patients with an ICD implanted

Objective Malignant ventricular arrhythmias, ventricular tachycardia(VT)or ventricular fibrillation(VF), are the main reasons of sudden cardiac death. Commonly, VT appears first and then can deteriorates into VF. Antitachycardia pacing(ATP)has been proved to be an effective method to terminate VT. Our study aimed to evaluate the efficacy of ATP on VT in 172 patients. Methods One hundred and seventy-two patients(male in 137, female in 35, mean age of 52.8 years), including 103 patients who had a prior history of Adams-stokes attacks,underwent ICD implantation. Among them, 137 patients had VT/VF records before implantation procedure. During the follow-up period, the efficacy of ATP on VT was evaluated with interrogation of the ICD memory. Results During the mean follow-up of 37 months, a total of 1 473 VT episodes were terminated by ICD. Among them, 981 VT episodes were terminated by ATP(66.6%)and 492 by cardioversion(CV). Among 981 VT episodes successfully terminated by ATP, 513 events(52.3%)were terminated by first run of ATPs. Conclusion ATP therapy for VT is successful in the large majority of episodes. For patients with a prior history of VT, ATP is superior to CV and shock, in terms of reduction of ICD discharges, prolonging life of ICD and not painful.