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目的:通过对快速性室性致死性心律失常具备埋藏式心脏复律除颤器(ICD)植入适应证的患者进行ICD植入治疗,评价ICD治疗快速性室性致死性心律失常的疗效。方法:对2005-2009年我科收治的18例快速性室性致死性心律失常患者植入ICD,其中缺血性心肌病11例,扩张性心肌病7例。植入心脏再同步化治疗除颤器(CRTD)9例,双腔ICD5例,单腔ICD4例。结果:所有患者植入手术均获成功。术后随访2～43个月,无手术相关并发症。3例患者术中经1次低能T波同步电击诱发心室颤动(VF),均一次复律成功,除颤阈值10～20J。在同时服用抗心律失常药物下,5例患者共9次发生室性心动过速(VT)和(或)VF,ICD识别及转复或放电治疗成功。2例单腔ICD患者各发作一次心房纤颤,被误诊为VT,并导致误治,启动稳定性及宽度两个诊断功能后,随访半年未再出现误诊及误治。9例随访期内曾发作室上性心动过速,通过抗心动过速起搏转复。9例CRTD随访心脏彩超EF由30%～35%改善至35%～50%,心衰症状明显改善,生存质量得到了提高。结论:ICD是恶性室性心律失常的首选治疗措施。CRTD兼具心室再同步起搏的特点,适用于心功能不全同时合并恶性室性心律失常的患者,可明显提高生存质量,改善心功能,延长生存期。
OBJECTIVE: To evaluate the efficacy of ICD in the treatment of rapid ventricular arrhythmias by ICD implantation in patients with tachycardia cardioverter-defibrillator (ICD) indications for rapid ventricular arrhythmia. Methods: ICD was performed in 18 patients with rapid ventricular arrhythmia admitted in our department from 2005 to 2009, including 11 cases of ischemic cardiomyopathy and 7 cases of dilated cardiomyopathy. 9 cases of cardiac resynchronization therapy defibrillator (CRTD), 5 cases of double chamber ICD and 4 cases of single chamber ICD were implanted. Results: All patients were successfully implanted. Postoperative follow-up of 2 to 43 months, no surgical complications. Ventricular fibrillation (VF) was induced by one low-energy T-wave electric shock in 3 patients. All of them were successful in one cardioversion and the defibrillation threshold was 10-20J. Five patients underwent ventricular tachycardia (VT) and / or VF, ICD recognition, and successful treatment of rewarming or discharging in combination with antiarrhythmic drugs. Two patients with single-chamber ICD developed episodes of atrial fibrillation, which were misdiagnosed as VT and resulted in misdiagnosis and initiation of stability and width of two diagnostic functions. Nine cases had a supraventricular tachycardia during the follow-up period and were resuscitated by anti-tachycardia pacing. 9 cases of CRTD follow-up echocardiography EF by 30% to 35% to 35% to 50%, heart failure symptoms improved significantly, the quality of life has been improved. Conclusion: ICD is the preferred treatment for malignant ventricular arrhythmias. CRTD has the characteristics of both ventricular resynchronization pacing, suitable for patients with cardiac dysfunction and malignant ventricular arrhythmia, can significantly improve the quality of life, improve cardiac function and prolong survival.