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目的评估本中心置入埋藏式心脏转复除颤器(ICD)患者的室性心律失常[室性心动过速(VT)/心室颤动(VF)]发生及治疗状况。方法连续入选本中心于2004年1月至2014年6月置入ICD或CRTD并规范随访的患者,收集术前资料、术后VT/VF发生及治疗情况。结果共分析76例患者,其中一级预防32例,二级预防44例,43例(56.6%)存在严重心功能不全(左室射血分数<0.35)。随访13个月至10年,无一例死于VT/VF。22例(28.9%)发生ICD恰当治疗,15例(19.7%)发生不恰当治疗。一级预防患者VT/VF发生率低于二级预防组(9.4%vs 43.2%,P=0.001)。冠心病亚组一级预防与二级预防VT/VF发生率无差别(20%vs 55.6%,P=0.21),而扩张型心肌病组一级预防低于二级预防(8%vs 50%,P=0.009)。不同病因的二级预防患者VT/VF发生率无差异。单腔与双腔(包括三腔)ICD的不恰当治疗率分别是28.1%vs 13.6%(P=0.11)。结论 ICD能有效预防室性心律失常性死亡,二级预防及缺血性心肌病患者ICD恰当治疗率高,而一级预防患者中扩张型心肌病VT/VF发生率较低。双腔ICD的不恰当治疗率较单腔有减少的趋势。
Objective To assess the occurrence and treatment of ventricular arrhythmias (ventricular tachycardia (VT) / ventricular fibrillation (VF)) in our center with implanted cardioverter defibrillators (ICD). Methods The patients were enrolled in ICD or CRTD and were followed up regularly from January 2004 to June 2014 in our center. Preoperative data, postoperative VT / VF occurrence and treatment were collected. Results A total of 76 patients were analyzed. Among them, 32 cases were prevented by primary prevention, 44 cases were secondary prevention and 43 cases (56.6%) had severe heart failure (LV ejection fraction <0.35). All cases were followed up for 13 months to 10 years. None died of VT / VF. Twenty-two patients (28.9%) received proper ICD and 15 (19.7%) received inappropriate treatment. The incidence of VT / VF in primary prevention was lower than in secondary prevention (9.4% vs 43.2%, P = 0.001). There was no difference between primary prevention and secondary prevention of VT / VF in CHD subgroup (20% vs 55.6%, P = 0.21), while primary prevention in dilated cardiomyopathy group was lower than secondary prevention (8% vs 50% , P = 0.009). There was no difference in the incidence of VT / VF between secondary prevention patients with different etiologies. The inappropriate treatment rates for single- and double-lumen (including triple-lumen) ICDs were 28.1% vs 13.6%, respectively (P = 0.11). Conclusion ICD can effectively prevent ventricular arrhythmic death. Secondary prevention and ischemic cardiomyopathy patients with ICD appropriate treatment rate is high, and primary prevention in patients with dilated cardiomyopathy VT / VF incidence is low. Inappropriate dual lumen ICD treatment rates tend to decrease compared with single lumen.