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目的:初步总结应用心脏再同步化治疗除颤器(CRT-D)治疗慢性心力衰竭(CHF)合并恶性室性心律失常的临床体会。方法:选取的6例CHF患者均为心功能Ⅲ～Ⅳ级(NYHA分级),且有恶性室性心律失常发作史,体表心电图QRS波>0.12s,术前组织多普勒超声检查均提示存在心脏收缩不同步,药物治疗无效。置入CRT-D。随访观察患者临床症状、心功能、左室射血分数(LVEF)变化及室性心律失常的发生情况。结果:CRT-D置入术中右心房、左心室起搏电极感知和起搏参数均符合要求,右心室除颤电极的感知、起搏及除颤阈值良好。起搏前QRS时限平均189ms,起搏后平均142ms。随访6～36个月,心功能较术前明显改善,LVEF术前平均0.33,术后6个月平均0.47。6例患者随访期间共发生室性心动过速2次,CRT-D均以31～34J的能量1次除颤成功。结论:CRT-D不仅可有效改善CHF患者的临床症状,增加LVEF,改善心功能。同时可有效治疗室性心动过速等恶性室性心律失常,预防心脏性猝死。
OBJECTIVE: To summarize the clinical experience of cardiac resynchronization therapy with defibrillator (CRT-D) in the treatment of patients with chronic heart failure (CHF) complicated with malignant ventricular arrhythmias. Methods: All the 6 CHF patients were classified as NYHA class Ⅲ, with a history of malignant ventricular arrhythmia, QRS wave of body surface electrocardiogram> 0.12s, preoperative tissue Doppler echocardiography Systolic heart sync exists, drug treatment is invalid. Into the CRT-D. Follow-up observation of clinical symptoms, cardiac function, left ventricular ejection fraction (LVEF) changes and ventricular arrhythmias occurred. Results: The parameters of right atrium and left ventricular pacing electrode were all accordant with the requirements of right ventricular and pacing parameters. The threshold of right ventricular defibrillation electrode and pacing and defibrillation were good. The QRS duration was averaged 189 ms before pacing and 142 ms after pacing. The follow-up ranged from 6 to 36 months. Cardiac function improved significantly compared with that before operation. The mean LVEF before operation was 0.33 and the average was 0.47 at 6 months after operation. Ventricular tachycardia occurred twice during follow-up, and CRT- ~ 34J energy 1 defibrillation success. Conclusion: CRT-D can not only effectively improve the clinical symptoms of CHF patients, increase LVEF and improve cardiac function. At the same time can be effective treatment of ventricular tachycardia and other malignant ventricular arrhythmias, prevention of sudden cardiac death.