摘要
目的 评价经静脉心律转复除颤器 (ICD)对恶性室性心律失常的治疗作用。方法 6例药物难治性反复发作的室性心动过速 (VT)及 /或心室颤动 (VF)患者接受经静脉ICD治疗 ,并随访 12±7 0月 (1～ 2 1月 )。其中冠心病 2例 ,扩张型心肌病 1例 ,原发性室颤 3例。结果 6例成功地置入经静脉ICD ,脉冲发生器埋于左上胸皮下 5例 ,胸大肌与胸小肌之间 1例。 3例经ICD储存资料证实共发生VT45 1次 ,均被ICD有效终止。 3例患者共有 6次VT经电击复律成功。 2例分别因窦性心动过速和心房颤动而误放电 ,其中 1例因口服胺碘酮致VT频率减慢至VT探查窗口以下而未被ICD察觉 ,经程控调整有关设置后得以纠正。结论 经静脉ICD是一种植入方法简单、能有效终止恶性室性心律失常和减少心律失常性死亡的重要手段。定期随访和针对患者改变的心律失常状况的再程控 。
Objective To assess the antiarrhythmic effect of transvenous implantable cardioverter-defibrillator(ICD) on malignant ventricular arrhythmias.Methods Six patients with refractory and recurrent ventricular tachycardia(VT) and/or ventricular fibrillation received transvenous ICD.The underlying diseases were coronary artery disease in 2 patients,dilated cardiomyopathy in 1 patient,and idiopathic ventricular fibrillation in 3 patients.The average duration of follow-up was 12±7 0 months(range1～21 months).Results Transvenous ICDs were successfully implanted in left chest subcutaneous pocket in 5 patients and left pectoral muscular pocket in 1 patient.The storage data revealed that in 3 patients 451 episodes of VT were detected which were terminated by ICDs.3 patients successfully experienced 6 times electrical cardioversion after implanation.Erroneous electrial discharge occurred in 2 patients because of sinus tachycardia and atrial fibrillation.In one patient,ICD failed to detect VT because of slow rate of VT out of detectable rate zone of VT during amiodarone treatment.This was successfully corrected by reprogramming related parameters.Conclusion Transvenous ICD is easy to implant,and provides a satisfactory means in termination of life-threatening ventricular arrhythmias and reduction of arrhythmic mortaliy.A regular check-up and reprogramming of the device may be needed during follow-up when the patients arrhythmic conditions are changed.
出处
《临床心电学杂志》
2002年第1期15-17,共3页
Journal of Clinical Electrocardiology
