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目的探讨CRT-D置入过程中是否需常规行除颤阈值(DFT)测试。方法选取2008年6月～2009年10月所有符合适应证的CRT-D置入患者,行左锁骨下静脉穿刺或头静脉切开,按标准方法置入左心室电极导线,右心室除颤电极导线置于心尖部,右心房电极导线置入右心耳处,对于各项参数测试满意者未行除颤阈值(DFT)测试,根据经验设置成20J。患者术后行常规随访,记录和分析CRT-D记录的事件并进行优化;若患者出现病情变化,随时进行CRT-D程控。随访期间全程予患者优化的药物治疗。结果共入选患者22例(窦性心律19例),其中男性20例,年龄63.1±10.5岁;扩张型心肌病患者17例,缺血性心肌病患者5例;左室舒张末期内径74.5±13.8mm,LVEF28.6±3.8%,QRS时限143.8±18.5ms。随访1～16月,记录到室性心律失常事件的患者4例,其中1例因低钾血症诱发多形性室性心动过速反复发作达28次,CRT-D均能有效识别和转复;2例患者因ATP未能终止室性心动过速发作,予以除颤成功;1例患者ATP有效转复。结论各项参数测试满意,未行常规CRT-DDFT测试的患者可同样有效终止室性心律失常的发生。
Objective To investigate whether the conventional defibrillation threshold (DFT) test should be performed during CRT-D implantation. Methods All eligible CRT-D patients were selected from June 2008 to October 2009 and underwent left subclavian vein puncture or cephalic vein incision. Left ventricular electrode leads, right ventricular defibrillation electrodes The lead was placed on the apical part and the right atrial electrode lead was inserted into the right atrial appendage. The defibrillation threshold (DFT) test, which was not satisfactory for all parameters tested, was set to 20 J according to experience. Patients were routinely followed up, recorded and analyzed CRT-D recorded events and optimized; if the patient changes in the condition, CRT-D program control at any time. During the follow-up to patients optimized medication. Results A total of 22 patients (sinus rhythm 19 cases) were enrolled, including 20 males, aged 63.1 ± 10.5 years, 17 cases of dilated cardiomyopathy, 5 cases of ischemic cardiomyopathy and 74.5 ± 13.8 of left ventricular end-diastolic diameter mm, LVEF 28.6 ± 3.8%, QRS duration 143.8 ± 18.5 ms. During the follow-up period of 1 to 16 months, 4 patients were recorded with ventricular arrhythmia, of which 1 case had repeated episodes of pleomorphic ventricular tachycardia induced by hypokalemia for 28 times. CRT-D could be effectively identified and transferred Complex; 2 patients due to ATP failed to terminate the onset of ventricular tachycardia, defibrillation was successful; 1 patient with ATP effectively restored. Conclusions All parameters were satisfactorily tested. Patients who did not perform conventional CRT-DDFT testing were also able to effectively terminate ventricular arrhythmias.