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目的总结具有心脏再同步化治疗(CRT)和埋藏式自动复律除颤器(ICD)功能的心脏再同步化治疗除颤器(CRT-D)用于临床治疗慢性心力衰竭(心衰)的初步经验。方法 17例药物治疗无效的慢性心衰患者接受了 CRT-D 治疗,其中6例患者接受了具有心衰预警功能的 InSync Sentry。基础病因为扩张性心肌病12例,缺血性心肌病5例;13例患者既往有室性心动过速或心室颤动的发作病史。结果 17例患者均成功置入 CRT-D,左室导线平均起搏阈值为1.6 V,除颤阈值≤20 J,无并发症发生。平均随访13个月,5例患者发生室性心动过速诱发的电击除颤。1例置入 InSync Sentry的患者由于心功能恶化出现2次心衰报警事件,药物治疗后好转。结论 CRT-D 置入手术相对安全,不仅能改善患者心功能,而且可预防心脏性猝死的发生。
Objective To summarize the clinical application of cardiac resynchronization therapy defibrillator (CRT-D) with cardiac resynchronization therapy (CRT) and buried auto-defibrillator (ICD) in the treatment of chronic heart failure Preliminary experience. Methods Seventeen patients with refractory chronic heart failure underwent CRT-D. Six patients received InSync Sentry with early warning of heart failure. The underlying causes of dilated cardiomyopathy in 12 cases, 5 cases of ischemic cardiomyopathy; 13 patients with previous history of ventricular tachycardia or ventricular fibrillation. Results All 17 patients were successfully treated with CRT-D. The average left ventricular pacing threshold was 1.6 V and the defibrillation threshold was ≤ 20 J, with no complication. The average follow-up of 13 months, 5 patients with ventricular tachycardia induced shock defibrillation. One patient with InSync Sentry had two heart failure alarms due to deteriorating cardiac function, which improved after treatment. Conclusion CRT-D surgery is relatively safe, not only can improve the patient’s cardiac function, but also prevent the occurrence of sudden cardiac death.