6例埋藏式心脏转复除颤器频繁电击分析与处理

摘要

目的分析6例埋藏式心脏转复除颤器( ICD)患者术后频繁电击的临床特点。方法回顾2008年至今42例ICD植入患者中6例术后频繁电击的临床资料。结果6例发生频繁电击(发生率14.3%),随访8~38个月,死亡1例。1例CRT-D患者半年内发生6次ICD电风暴,多为反复发生室性心动过速( VT)、快VT( FVT),抗心动过速起搏( ATP)无效升级为电击治疗或者ATP诱发FVT、心室颤动( VF)而行电击治疗,首次电风暴9个月后死于顽固心力衰竭；1例左上腔植入单腔ICD患者出现3次血流动力学稳定的VT事件频率进入VF诊断区直接电击治疗6次且无效；1例单腔ICD 患者因T波过感知致11次误放电；1例双腔ICD患者出现3次血流动力学稳定的VT事件,ATP失败后电击治疗6次且无效,此3例均经优化程控后无电击事件。1例CRT-D患者因右室电极脱位至三尖瓣环处致P、R双计数误识别为3次VF并予电击,经再次手术复位后无类似事件。1例CRT-D患者极短期内因2次VF事件及1次VT事件,10阵ATP无效而先后3次电击治疗,优化药物及程控后无电击事件。结论ICD术后频繁电击病因及诱因治疗是预防发生和及时终止的基础,优化药物及程控治疗可降低对电击治疗的需求及误放电的发生,必要时手术调整或导管消融。%Objective To analyze frequent discharge events among 6 patients with implantable cardioverter defibrillator (ICD). Method Since 2008, 42 patients were implanted ICD, clinic materials of 6 cases with frequent discharge e-vents were reviewed and analyzed. Results ①General materials:34 patients were followed up, 6 cases (3 males)had been subjected frequent discharge events( the incidence was 14. 3%), aged from 38 to 67 years, included 2 CRT-D for di-lated cardiomyopathy with VT/VF, 1 single chamber ICD for long Q-T syndrome with PVC/VT/VF, 1 single chamber ICD for idiopathic ventricular fibrillation, 1 double chamber ICD and 1 CRT-D for ischemic cardiomyopathy with VT;②Frequent discharge events:One patient with CRT-D experienced 17 discharges in half a year for repeated and non-silent VT/FVT af-ter failed ATP, died of obstinate heart failure 9 months after first discharge event; One with single chamber ICD surffered from 6 ineffective discharges for 3 sustain VT events that matched VF frequency diagnostic criteria in a short time;One with single chamber ICD underwent 11 imappropriate discharges for T wave oversensing;One with double chamber ICD encoun-tered 6 ineffective discharges for 3 sustain VT events after failed ATP in 40 minutes;One with CRT-D happened 3 imappro-priate charges for VF events that caused by P/R-wave double count;The other with CRT-D ) had been subjected 3 discharges for 2 VF and 1 VT after 10 sequences inefficient ATP in several hours. Among the survivors, one received second operation, the others received optimizing drug therapy and/or parame-ter re-programing, after fellow-up, frequent discharge e-vent hadn’t occured; Conclusion After ICD was im-planted, frequent discharge is an emergency event, we should promptly search the causes and treat, it is impor-tant to optimize drug therapy and parameter re-progra-ming, sometimes operative correction will be unavoidable.