经静脉置入型心律转复除颤器临床应用(摘要)
作者：严激 徐健 范西真 丁晓梅 刘伏元 韩小萍 王家生 顾统元
单位：安徽省合肥市，安徽省立医院 心内科(230001)
关键词：
目的 目的：为控制药物难治性室性心动过速(室速)及心室颤动(室颤)，2例患者采用经静脉置入型心律转复除颤器(ICD)治疗。
方法：2例器质性心脏病(陈旧性心肌梗塞及扩张型心肌病)伴室速或室颤，抗心律失常药物无效，均在胸部置入，经静脉单根电极导线置于右心室心尖部。除颤电流由右心室心内线圈状电极至除颤器外壳本身。
结果：2例患者均成功地置入了经静脉单导线ICD，除颤阈值均<15 J,无手术并发症发生。随访期间：1例术后发生9次室颤，均经1次高能量除颤终止，该例术后第4个月反复发作室颤伴血液动力学恶化而死亡。另1例因口服普罗帕酮而使室速频率减慢，小于设置室速频率窗口而未被ICD察觉，随后程控调整室速频率窗口。
结论：经静脉置入型心律转复除颤器除颤效果肯定、置入方法较简单。
Clinical Application of Transvenous Implantable Cardioverter Defibrillator (Abstract)
Department of Cardiology, Anhui Provincial Hospital, Hefei (230001), Anhui
Yan Ji, Xu Jian, Fan Xizhen, et al.
Objective: Implantable cardioverter-defibrillator (ICD) were implanted in two patients with drug refractory vertricular tachycardia (VT) and ventricular fibrillation (VF).
Methods: Two patients were with organic heart disease (one case of old myocardial infraction, and the other of dilated cardiomyopathy) and had history of VT or VF. Antiarrhythmic drug therapy was unsuccessful. ICD was implanted in the chest pocket by nonthoracotomical approach. The pulse generator was connected with a single intravenous lead. Shocks were delivered through distal coil to the ICD shell.
Results: Two patients had successful implantation using single lead ICDs. The defibrillation threshold was less than 15 J. No operative and perioperative complication occurred, during follow-up, one patient had VF and was terminated by defibrillation, but 4 months after implantation the patient died due to necurrent VF; the other one after using of propaferone had recurrent VT with slow rate, which was not detected by the ICD, the VT window was reprogrammed.
Conclusion: Transvenous implantation of single lead ICDs is easy to perform and is an effective approach to treat ventricular arrhythmias., http://www.100md.com
单位：安徽省合肥市，安徽省立医院 心内科(230001)
关键词：
目的 目的：为控制药物难治性室性心动过速(室速)及心室颤动(室颤)，2例患者采用经静脉置入型心律转复除颤器(ICD)治疗。
方法：2例器质性心脏病(陈旧性心肌梗塞及扩张型心肌病)伴室速或室颤，抗心律失常药物无效，均在胸部置入，经静脉单根电极导线置于右心室心尖部。除颤电流由右心室心内线圈状电极至除颤器外壳本身。
结果：2例患者均成功地置入了经静脉单导线ICD，除颤阈值均<15 J,无手术并发症发生。随访期间：1例术后发生9次室颤，均经1次高能量除颤终止，该例术后第4个月反复发作室颤伴血液动力学恶化而死亡。另1例因口服普罗帕酮而使室速频率减慢，小于设置室速频率窗口而未被ICD察觉，随后程控调整室速频率窗口。
结论：经静脉置入型心律转复除颤器除颤效果肯定、置入方法较简单。
Clinical Application of Transvenous Implantable Cardioverter Defibrillator (Abstract)
Department of Cardiology, Anhui Provincial Hospital, Hefei (230001), Anhui
Yan Ji, Xu Jian, Fan Xizhen, et al.
Objective: Implantable cardioverter-defibrillator (ICD) were implanted in two patients with drug refractory vertricular tachycardia (VT) and ventricular fibrillation (VF).
Methods: Two patients were with organic heart disease (one case of old myocardial infraction, and the other of dilated cardiomyopathy) and had history of VT or VF. Antiarrhythmic drug therapy was unsuccessful. ICD was implanted in the chest pocket by nonthoracotomical approach. The pulse generator was connected with a single intravenous lead. Shocks were delivered through distal coil to the ICD shell.
Results: Two patients had successful implantation using single lead ICDs. The defibrillation threshold was less than 15 J. No operative and perioperative complication occurred, during follow-up, one patient had VF and was terminated by defibrillation, but 4 months after implantation the patient died due to necurrent VF; the other one after using of propaferone had recurrent VT with slow rate, which was not detected by the ICD, the VT window was reprogrammed.
Conclusion: Transvenous implantation of single lead ICDs is easy to perform and is an effective approach to treat ventricular arrhythmias., http://www.100md.com