埋藏式心脏转复除颤器误治疗原因分析

目的分析埋藏式心脏转复除颤器(ICD)误治疗的主要原因并探讨应对策略。方法对30例符合纳入标准的ICD植入病人进行随访分析,其中心脏性猝死一级预防23例,二级预防7例;单腔ICD17台,双腔ICD13台(包括CRT-D4台)。术后3个月进行常规随访,以后每6个月随访1次。随访期间如果病人自觉ICD放电或其它相关症状尽早至医院随访。由2位有经验的电生理专业医生根据ICD治疗事件心内电图对ICD治疗方式进行分类,如果治疗不是针对室性心动过速(VT)或心室颤动(VF)则该治疗定义为误治疗。结果78例次随访中,45次ICD治疗事件包括36次抗心动过速治疗(ATP)和9次放电,其中误治疗33次(73%),包括27次ATP治疗和6次放电。33次误治疗共涉及5例病人(17%),均为单腔ICD。误治疗的原因均为室上性快速性心律失常(SVT-A)。结论误治疗是比较常见的ICD相关事件。植入ICD后应尽早打开SVT-A相关的诊断功能。

Analysis of the inappropriate therapies of implantable cardioverter-defibrillator

Objective To identify preliminarily the main causes of the inappropriate therapy of Implantable Cardioverter-Defibrillator（ICD） and find a way for troubleshooting. Methods Among 30 enrolled cases, 23 cases were for primary prevention of cardiac death and 7 cases for secondary prevention. Seventeen patients were implanted single-chamber ICD and 13 were dual-chamber ICD （4 CRT-D cases included）. The patients were followed up 3 months after implantation and every 6 months after that. They also were suggested to see doctors as early as possible if ICD shocks or related symptoms experienced. Two electrophysiologists would review and reevaluate the appropriateness of ICD therapy in stored intraeardiae electrocardiogram. Any ICD therapy not delivered for VT or VF was deemed to be inappropriate therapy. Results Forty five ICD therapy events were found during 78 case-times follow-up, including 36 anti-taehycardia pacing （ATP） therapies and 9 shocks. Thirty three therapies （73 % ） in 5 patients were classified inappropriate, including 27 ATP therapies and 6 shocks. All inappropriate therapies were caused by supraventricular tachyarrhythmias. Conclusion Inappropriate therapies are very common in patients with ICD implantation. A good combined detection algorithms for supraventricular taehyarrhythmias can minimize the inappropriate therapy.