埋藏式心脏转复除颤器的随访

目的报道37例埋藏式心脏转复除颤器(ICD)的随访结果。方法对置入ICD的37例患者进行电话询问和门诊随访,通过常规心电图、动态心电图及ICD存储的资料,对患者病情和ICD工作情况进行分析。结果37例患者共发作室性心动过速/心室颤动(VT/VF)917次(VT745次,VF172次),其中911次(99.3%)治疗成功,6次(0.7%)失败。非持续性VT122次(16.4%),发作均自行停止。623次持续性VT(83.6%)中,537次(86.2%)经抗心动过速起搏(ATP)终止,82次(13.2%)经低能量复律(CV)终止,3次(0.4%)在ATP治疗过程中加速为VF,由高能量除颤(DF)终止。172次VF中,167次(97.1%)经DF终止,1例无效放电5次(2.9%)系因电池提前耗竭而更换了ICD脉冲发生器,2例共8次阵发性心房颤动心室率超过设置的VT频率ICD发生误识别,给予ATP治疗。5例术后1~6个月出现心律失常“电风暴”。5例对电击恐惧造成了不同程度的心理障碍,经教导必要时辅以药物治疗后症状得以缓解。共有19例术后因VT发作频繁而服用胺碘酮/美托洛尔,并根据心律失常发作情况调整用药剂量。结论ICD置入后应加强随访,及时调整工作参数,同时辅助药物、改善心功能和心理治疗。

Clinical follow-up of patients with implantable cardioverter defibrillators

Objective To report the follow-up results of 37 patients with implantable cardioverter defibrillators (ICD). Methods Telephone inquiry and out-patient department follow-up of patients with ICD implanted were performed.the data stored in ICD and body surface electrocardiogram as well as ambulatory electrocardiogram monitoring were analyzed. Results In the average follow-up period of 16 months,34 out of 37 patients (92.0%) received ICD therapy.The cumulative data stored in ICD showed that total 917 episodes of ventricular tachycardia /ventricular fibrillation (VT/VF) were detected by the devices, 745 of them were VT, and 127 out of 745 were nonsustained VT which spontaneously terminated. 622 (99.8%) VT episodes were treated by ICD successfully. 537 (86.2%) were terminated by ATP and 82(13.2%) by low energy cardioversion. 3 (0.4%) VT were accelerated to VF and terminated by high energy shocks.172 of them were VF, 167 (97.1%) terminated by shocks, and 5 episodes did not terminated due to incessant VT in one patient by electrical exhaustion of ICD,and then the ICD was changed. Conclusions ICD with tiered therapy function has high efficacy of termination of ventricular tachyarrhythmias. It is very important to follow-up the patients and set appropriate parameters of diagnosis and therapy of ICD.