134例植入型心律转复除颤器植入患者的术后放电和误放电治疗特点

摘要

目的 分析植入型心律转复除颤器( ICD)植入患者的术后放电和误放电治疗的特点,并探讨其影响因素,明确其对患者远期死亡率的影响. 方法 回顾性分析2001年1月至2015年2月于北京大学人民医院植入ICD或在外院植入ICD于此随访的134 例患者的病历记录及随访资料,分析放电及误放电治疗发生的时间、次数、原因等特点,及其是否对患者远期死亡率产生影响.结果 134例患者年龄25～82岁,平均(48. 0 ± 19. 2)岁,男性90例(67. 2% ),因缺血性心肌病植入者33例(24. 6% ),因非缺血性心肌病植入者101例(75. 4% ).在平均(5. 1 ± 1. 6)年的随访时间内, 41例(30. 6% )患者发生了恰当放电治疗,其中缺血性心肌病患者10例(24. 4% ),非缺血性心肌病患者31例(75. 6% ),共发生恰当放电治疗336次,332次有效,总有效率为98. 8% . 8例(6. 0% )患者发生了误放电治疗,均为非缺血性心肌病患者,其中因心房颤动/房性心动过速/心房扑动/室上性心动过速导致者5例(62. 5% ),因电极断裂、噪声干扰导致者3例(37. 5% ),因心房过感知导致者1例(12. 5% ),有1例患者同时具有室上性心动过速和电极断裂/噪声干扰两种误放电治疗原因. 8例患者共发生88 次误放电治疗,心房颤动/房性心动过速/心房扑动/室上性心动过速导致者 12 次(13. 6% ),电极断裂/噪声干扰导致者56次(63. 6% ),心房过感知导致者20次(22. 7% ).放电治疗组与无放电治疗组相比,误放电治疗组与恰当放电治疗组相比,全因死亡率均无统计学差异. 结论 误放电治疗是ICD植入术后常见的并发症,心房颤动/房性心动过速/心房扑动/室上性心动过速、电极断裂/噪声干扰、感知异常等是导致ICD误放电治疗的常见原因.恰当放电治疗和误放电治疗未增加全因死亡率.%Objective To analyze the appropriate and inappropriate shock characteristics in patients with implantable cardioverter-defibrillator (ICD), explore the influence factors and their impact to mortality. Methods Checking the medical records and follow up data of 134 ICD patients in Pecking University People's Hospital from January 2001 to February 2015, analyze the time, frequency and reasons of their ICD shocks, and look into their impact on mortality. Results The 134 ICD patients aged 25-82 years, mean (48. 0 ± 19. 2) years old, 90 males ( 67. 2% ), 33 ( 24. 6% ) patients implanted ICD for ischemic cardiomyopathy, 101 (75. 4% ) patients implanted ICD for non-ischemic cardiomyopathy. During follow up of (5. 1 ± 1. 6) years, 41 (30. 6% ) patients had appropriate shock therapy and 8 (6. 0% ) patients had inappropriate shock therapy. The most common reasons for inappropriate ICD shocks were atrial fibrillation, supraventricular tachycardia, over-sensing and noise. Among the 88 inappropriate ICD shocks, 12 (13. 6% ) of them were due to atrial arrhythmias or supraventricular tachycardia, 56 (63. 6% ) of them were due to noise and 20 (22. 7% ) of them were due to over-sensing. When compared shock group with non-shock group, appropriate shock group with inappropriate shock group, there were no mortality differences between them. Conclusions Inappropriate shocks are common complications after ICD implantations, atrial fibrillation, atrial flutter, supraventricular tachycardia, atrial tachycardia, noise from lead fracture, and over-sensing are the common reasons. Either appropriate or inappropriate ICD shocks don??t increase all-cause mortality.