Alexander Mark E, Cecchin Frank, Walsh Edward P, Triedman John K, Bevilacqua Laura M, Berul Charles I
Arrhythmia Service, Department of Cardiology, Children's Hospital, Boston, Massachusetts 02115, USA.
J Cardiovasc Electrophysiol. 2004 Jan;15(1):72-6. doi: 10.1046/j.1540-8167.2004.03388.x.
The incidence of appropriate and inappropriate discharges, indicators of system failure, and clinical implications of implantable cardioverter defibrillator (ICD) therapy in children and young adults with heart disease is poorly defined.
In a retrospective study at a single medical center, a total of 90 ICD procedures were performed in 76 patients younger than age 30 years (median 16 years, range 1-30): 42% with congenital heart disease, 33% with primary electrical disease, 17% with hypertrophic cardiomyopathy, and 8% with idiopathic dilated cardiomyopathy. Indications for ICD included arrest or sustained ventricular tachycardia (n = 27), and combinations of syncope (n = 32), palpitations (n = 17), spontaneous ventricular arrhythmia (n = 40), inducible ventricular tachycardia (n = 36), or severe hypertrophic cardiomyopathy. Transvenous dual-chamber ICDs were implanted in 29 patients. Subcutaneous arrays or epicardial patches were used in 9 patients. Over a median 2-year follow-up, 28% of patients received appropriate shocks for ventricular tachycardia (median 13 months to first shock) and 25% experienced inappropriate shocks for multiple causes (median 16 months). With multivariate analysis, growth strongly correlated with lead failure (odds ratio 73, 3.5-1530, P = 0.006). Complications occurred in 29 patients, including lead failure in 16 (21%), ICD "storm" with sequential shocks in 5, and infection in 2 patients. No deaths were attributable to ICD placement or subsequent device failure.
ICD therapy can effectively manage malignant arrhythmias in selected pediatric and congenital heart patients. Spurious shocks or ICD storm may increase morbidity and emphasize the need for concomitant medical and ablative therapy. ICD lead failure was relatively frequent in this population.
在患有心脏病的儿童和年轻成人中，植入式心脏复律除颤器（ICD）治疗的合理与不合理放电发生率、系统故障指标及临床意义尚不明确。
在一家单一医疗中心进行的一项回顾性研究中，共对76名年龄小于30岁（中位数16岁，范围1 - 30岁）的患者进行了90次ICD植入手术：42%患有先天性心脏病，33%患有原发性电疾病，17%患有肥厚型心肌病，8%患有特发性扩张型心肌病。ICD的植入指征包括心脏骤停或持续性室性心动过速（n = 27），以及晕厥（n = 32）、心悸（n = 17）、自发性室性心律失常（n = 40）、诱发性室性心动过速（n = 36）或严重肥厚型心肌病的组合。29名患者植入了经静脉双腔ICD。9名患者使用了皮下阵列或心外膜贴片。在中位2年的随访中，28%的患者因室性心动过速接受了合理电击（首次电击的中位时间为13个月），25%的患者因多种原因经历了不合理电击（中位时间为16个月）。多因素分析显示，生长与导线故障密切相关（比值比73，3.5 - 1530，P = 0.006）。29名患者出现并发症，包括16名（21%）导线故障、5名出现ICD“风暴”并连续电击，以及2名患者发生感染。没有死亡可归因于ICD植入或随后的设备故障。
ICD治疗可有效管理特定儿科和先天性心脏病患者的恶性心律失常。假性电击或ICD风暴可能增加发病率，并强调需要同时进行药物和消融治疗。在这一人群中，ICD导线故障相对常见。
