目的：随访扩张型心肌病患者埋藏式心脏复律除颤器（ICD）对心脏性猝死（SCD）的一级预防作用。 方法：选取2013-12至2014-12浙江大学医学院附属第二医院心内科扩张型心肌病患者36例，其中男性29例（80.6%），女性7例（19.4%），平均年龄（63.0±11.8）岁。36例患者符合一级预防适应症并植入ICD者为ICD组（n=24），由于家庭条件等原因拒绝行ICD治疗的患者为对照组（n=12）。治疗后1、3、6个月随访,以后每6个月随访1次,观察患者的临床症状,随访时通过体外程控仪调出ICD 储存的资料进行分析,了解恶性心律失常的发生情况, ICD 的工作情况。 结果：24例ICD组患者经锁骨下静脉植入的植入CRT-D 10例（42%）,植入ICD 14例（58%），无并发症发生。36例患者随访6~18个月, ICD组患者中3例患者发生心室颤动（室颤）,均除颤成功,4例患者发生室性心动过速,抗心动过速起搏转复成功,1例患者因心房颤动快速心室率发生误放电,通过药物控制心室率及调整ICD 参数,未再发生误放电。ICD组随访时与本组入院时比较，除1例植入CRT-D的患者左心室射血分数（LVEF）下降以外，其余23例患者LVEF均较术前明显增高[（40.59±11.71）% vs （25.12±5.35）%]，与对照组随访期间比较LVEF 显著增加，差异均有统计学意义（P<0.05）；对照组患者心脏结构及左心室收缩功能均没有明显改善（P>0.05），LVEF无改善[（30.47±6.52）% vs （30.73±6.31）%，P>0.05]。 结论：ICD在扩张型心肌病患者SCD一级预防中疗效明确，可使心脏性猝死的高危患者获益。%Objective: To study the effect of primary prevention of implantable cardioverter Deifbrillator (ICD) on sudden cardiac death (SCD) in patients with dilated cardiomyopathy. Methods: A total of 36 patients with dilated cardiomyopathy treated in our hospital from 2013-12 to 2014-12 were studied including 29 (80.6%) male and 7 (19.4%) female with the mean age of (63±11.8) years. The patients were divided into 2 groups: ICD group, the patients had primary prevention indication with ICD implantation,n=24 and Control group, the patients refused ICD implantation for family and other reasons,n=12. The patients were examined at 1, 3 and 6 months after treatment and further follow-up study was performed every 6 months to observe clinical symptoms, analyze ICD stored data, understand the occurrence of malignant arrhythmia and to learn ICD working condition in relevant patients. Results: Subclavian implantation was conducted in all patients. In ICD group, there were 10 (42%) patients received CRT-D and 14 (58%) received ICD, no complication occurred. All 36 patients were followed-up for (6-18) months. In ICD group, 3 patients had ventricular fibrillation (VF) and defibrillation was succeed, 4 patients had ventricular tachycardia and anti-tachycardia pacing cardio-version was succeed, 1 patient had erroneous discharge due to the incidence of atrial fibrillation (AF) rapid ventricular rate and it was controlled by drug therapy and adjusted ICD parameters. Compared with admission time, ICD group had 23 patients with improved post-operative left ventricular ejection fraction (LVEF) (40.59±11.71) % vs (25.12±5.35) %; compared with Control group, ICD group had increased LVEF during follow-up period, allP<0.05. In Control group, there were no signiifcant improvement in cardiac structure, LV systolic function and LVEF (30.47±6.52) % vs (30.73±6.31), allP>0.05. Conclusion: ICD presented obvious effect on primary prevention of SCD in patients with dilated cardiomyopathy, the high risk patients of sudden cardiac death would be beneifcial.
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