埋藏式心脏复律除颤器在心脏性猝死一级预防中的作用

摘要

目的 探讨埋藏式心脏复律除颤器(ICD)在心脏性猝死(SCD)一级预防中的作用.方法 对35例在2006～2009年根据2005年ACC/AHC指南植入ICD进行SCD一级预防的患者,进行平均2年的临床随访数据分析.结果 (1)平均2年随访过程中,共11例患者(31.43％)发生室性心律失常事件,室颤除颤16阵次、室速启动抗心动过速起搏(ATP)79阵次,无误放电,无一例死亡；(2)室性心律失常事件,心肌致密化不全(NVM)发生率为100％、特发性室性心动过速(PVT) 66.67％、Brugada综合征50％、肥厚型心肌病(HCM)25％和(DCM) 16.67％；其中室颤PVT占87.5％(14阵次),DCM及Brugada综合征各1阵次；室速PVT占82.28％(65阵次)、NVM5阵次、HCM和Brugada综合征各4阵次和DCM患者1阵次,致心律失常右室心肌病未见室性心律失常事件；(3)术中术后未见植入ICD相关并发症,术后均未出现恶性室性心律失常所致晕厥,生活质量明显改善.结论 本组SCD高危患者中,平均ICD植入两年即在31.43％的患者中及时发现和纠正95次的恶性室性心率失常事件,其中对预防PVT、NVM和Brugada综合征的SCD最为明显,提示SCD高危人群中植入ICD进行一级预防有重要的临床价值.%Objective To evaluate the clinical effect of implanted cardioverter-defibrillators (ICD) for primary prevention of sudden cardiac death.Methods According to ACC/AHA Guideline of ICD implantation (2005),35 patients successfully received ICD/CRT-D implantation for primary prevention of sudden cardiac death in our hospital from January 2006 to December 2009.All the patients were followed up for a mean of 2 years.Results During the follow up,11 (31.43％) patients experienced entricular arrhythmic episodes,for which 16 defibrillation therapies and 75 anti-tachycardia pacing (ATP)therapies were delivered without mistaken shock or death.The incidence rate of NVM was 100％,that of PVT was 66.67％,Brugada syndrome 50％,HCM 25％ and DCM 16.67％.Of these episodes,the incidence of VF episodes among PVC patients was 87.5％ (14 beats),ventricular tachycardia PVC was 82.28％ (65 times),5 beats in NVM patients,4 beats in HCM and Brugada syndrome patients,and 1 beat in DCM patients.No ICD implantation-related complication was detected,and no ventricular tachycardia induced syncope occurred in these cases.All patients showed improved quality of life after the implantation.Conclusions ICD implantation can prevent malignant ventricular arrhythmia episodes,especially for PVT,NVM and Brugada syndrome in high risk SCD patients,demonstrating the value of implantation of ICD as a primary prevention in high-risk SCD patients.