除颤器植入患者发生心室电风暴慢室速时参数设置的研究

目的探讨植入型心律转复除颤器(implantable cardioverter defibrillator,ICD)植入患者发生心室电风暴慢室性心动过速(慢室速,150~180/min)时合理的ICD工作模式的参数设置。方法对我院ICD植入以心室电风暴慢室速急诊入院的11例常规予抗室速药物治疗,慢室速的治疗工作模式均随机选择抗心动过速起搏(ATP)的短阵快速起搏(BURST)5次后不转复即予体内电击(SHOCK)治疗(B5方案)和BURST 1次后不转复即予低能量SHOCK治疗(S1方案)。B5方案和S1方案,每种方案工作24 h,然后轮换,观察2周内慢室速总发作次数,B5方案和S1方案的总工作次数、复律成功率、室速治疗开始到成功的时间及患者耐受情况。结果本组共记录188 d,其中B5方案、S1方案各94 d。ICD共检测到慢室速204次,其中室速监测未治疗(VT-monitored)82次(有3次事件在ATP治疗前自行终止),室速监测并治疗122次(治疗应用B5方案65次,S1方案57次)。住院期间无死亡患者,B5方案和S1方案的转复成功率和SHOCK发生率比较差异无统计学意义(P0.05),但B5方案总ICD治疗时间较S1方案明显增加(P0.01)。结论 ICD植入发生心室电风暴慢室速患者ICD治疗方案应个体化,切忌盲目追求反复的抗心动过速起搏无痛治疗,以降低诱发心功能恶化的风险。

An ICD Programming Study for Patients with Electrical Storm after Implantation of Implantable Cardioverter Defib-rillator

Objective To study the implantable cardioverter defibrillator （ ICD） programming setting for patients with electrical storm （ slow ventricular tachycardia, 150-180 bpm） after implantation of ICD. Methods Eleven patients admitted to our hospital emergently with＆quot;ventricular electrical storm, slow ventricular tachycardia＆quot; after implantation of ICD were ran-domly selected. The ICD or CRTD programming settings were recorded, and routine anti-ventricular tachycardia drugs were given. Anti-tachycardia pacing （ ATP） setting of VT： BURST five times, then SHOCK in vivo without cardioversion （ B5 scheme） or BURST one time, then SHOCK with low energy and no cardioversion （ S1 scheme ） . The B5 scheme and S1 scheme, each worked 24 hours, and then changed to each other. Then we observed the total number of episodes, the total times of B5 scheme and S1 scheme, the success ratio of cardioversion, the ventricular tachycardia time, and the tolerance in patients. Results A total of 188 d were recorded and 94 d each with B5 scheme and S1 scheme. There were 204 times of slow ventricular tachycardia monitored by ICD, among which, 82 times were not treated （3 events stopped before ATP treat-ment）, and 122 times were monitored and treated （65 times of B5 scheme and 57 times of S1 scheme）. No patient died dur-ing hospitalization. Analysis showed that there was no significant difference in the rates of cardioversion success and SHOCK using between the B5 scheme and the S1 scheme （P〉0. 05）, but the treatment time was increased in B5 scheme than that in S1 scheme （P 〈0. 01）. Conclusion Patients with ICD implantation during ventricular electrical storm should be pro-grammed individually. Excessive pursuit of ATP painless therapy may increase the risk of heart failure.