摘要
对 16例埋置了埋藏式心脏复律除颤器 (ICD)的患者进行随访 ,以便及时调整ICD的诊断及治疗程序 ,予病人更恰当的治疗。 16例有晕厥史的恶性室性心律失常患者置入了ICD。根据电生理检查结果设定ICD的工作程序 ,随访时通过体外程控仪调出ICD储存的资料进行分析。在出院前及第一次心动过速发作后进行资料分析 ,术后每 3个月随访一次。平均随访 30个月。结果 :16例室性心动过速 (VT)发作 789次 ,其中 12 7次为非持续性VT ,均自行终止 ;6 6 1次 (99.9% )被ICD有效终止 ,其中 6 5 0次 (98% )由抗心动过速起搏 (ATP)终止 ,9(1.4 % )次由低能量 (小于 10J)转复终止 ,2次 (0 .3% )在ATP治疗过程中加速转为VF ,由高能量除颤终止 ,1次自行终止。ICD诊断的VF共 37次 ,均被成功转复。随访过程中 2例更换过ICD ,但保留原导管系统 ,1例术后死于心力衰竭 ,1例自杀。结论 :术后严密随访及时调整工作参数 ,并在随访过程中关注患者的心理健康 ,针对性的心理支持和治疗 ,对提高ICD的治疗效果至关重要。
16 patients,male 7 and femal 9,mean age 49 years with implantable cardioverter-defibrillator(ICD)were followed up in order to give them an approprate treatment by changing the programsetting .16 patients with malignant ventricular tachycardia (VT) underwent implantation of ICD with multitherapies including antitachycardia pacing (ATP),cardioversion,defibrillation and data storing function.The working program of ICD was set up according to the results of electrophysiologic study.Follow-up evaluation of patients after ICD implantation was conducted before discharge,after the first spontaneous arrhythmia event and every 3 months after discharge.Result: In the follow-up of 30 months,the storage data revealed that 789 episodes of VT were detected and 127 of them were nonsustained VT which spontaneously terminated.661(99.9%)VT episodes were treated by ICD successfully.650 (98%) were terminated by ATP and 9(1.4%) by low energy cardioversion.2 (0.3%)VT were accelerated to VF and terminated by energy shocks.There were 37 VF episodes diagnosed by the devices.All the episodes were terminated by shocks.2 patients changed ICD.The original catheter system could be used continuously. During the follow-up one patients died of heart failue and the other died of suicide.Conclusion:Careful postoperative observation and reprogramming after spontaneous event are necessary.Psychological supports and therapies should be done to the paced patients.
出处
《中国心脏起搏与心电生理杂志》
2003年第5期358-360,共3页
Chinese Journal of Cardiac Pacing and Electrophysiology
