经静脉埋藏式三腔起搏心脏转复除颤器的临床应用

探讨经静脉埋藏式三腔起搏心脏转复除颤器 (BVP ICD)的临床应用。病例入选标准 :①缺血性心脏病、扩张性心肌病合并充血性心力衰竭。②左室射血分数 <0 .35。③QRS波时限 >130ms。④ 2 4h动态心电图、临床心电监护、腔内电生理检查中 ,任一项记录到明确室性心动过速 (VT)或心室颤动 (VF)。采用经锁骨下静脉和头静脉 ,分别置入右室电极导管到右室 ,右房电极导管到右心耳 ,左室电极经冠状静脉窦到冠状静脉后侧支 ,其中 1例为经静脉埋藏三腔双室起搏器 (BVP)升级为BVP ICD。结果 :双室起搏阈值 1.7± 0 .7V ,R波幅度 10 .3± 4mV ,双室电极阻抗 896 .2± 82Ω。4例先后 2次采用电击T波诱发出VT或VF ,并除颤成功。 3例因心功能差仅诱发 1次并除颤成功。最低有效除颤能量 2例 11J ,5例 2 0～ 2 1J ,手术时间 12 9.2 8± 4 7.3min。 7例随访 3～ 12个月 ,心功能改善 1～ 2级。 2例分别各有 1例除颤事件记录 ,7例全部存活。结论 :BVP ICD临床疗效较好 ,但设定首次电击能量时不宜太小 ,力争尽快转复心律 ,以策安全。慎用快速心室起搏 (Ramp)终止VT。

Application of the Implantable Biventricular Pacing-Cardioverter Defibrillator

Discuss the application of the implantable biventricular pacing-cardioverter defibrillator (BVP-ICD). Indication: ①Organic heart disease and congestive heart failure. ②The left ventricular ejection fraction was less than<0.35. ③QRS duration >0 ms. ④Holter ,telemetry, electrophysiology study, one of them showed confirmed ventricular tachycardia (VT) or ventricular fibrillation (VF).Transvenous implanted right ventricle,right atrum lead to right ventricle apex and right atrum appendage respectively .Left ventricle lead to posterior branch of coronary sinus .one of the cases upgrade to BVP-ICD from Biventricular pacing(BVP). Results: Average biventricular threshold 1.7±0.7 V, R wave sensing 10.4±4 mV, impedance 896.2±82 Ω. 4 cases were induced VT or VF with T shock twice ,3 cases were induced VT or VF with T shock only one time, both defibrillation were successful .Minimal shock energy of successful defibrillation were 11J in 2 cases and 20～21 J in 5 cases. Average procedure time 129.28±47.3 min. During follow-up of 3～12 months,cardiac function increased 1～2 class and two cases had once cardiac defibrillation event.All cases were alive. Conclusion:BVP-ICD has a better clinical effect. The energy of first shock should enough to succeed defibrillation in case the VT turn to VF, because of the bad condition of heart failure. There is possibility of changing VT to VF by ramp therapy.