植入式除颤器对室性快速心律失常患者进行不适当心脏复律检测与治疗的发生率及原因

Incidence and causes of inappropriate detection and therapy by implantable defibrillators of cardioversion in patients with ventricular tachyarrhythmia.

作者信息

Chen Ruo-han, Chen Ke-ping, Wang Fang-zheng, Hua Wei, Chen Xin, Zhang Shu

机构信息

Centre of Arrhythmia Diagnosis and Treatment, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China.

出版信息

Chin Med J (Engl). 2006 Apr 5;119(7):557-63.

PMID:16620696

Abstract

BACKGROUND

Implantable cardioverter defibrillator (ICD) is the only effective therapy in patients with life threatening ventricular arrhythmias. Inappropriate detection and therapy by ICDs are the most common causes of side effects that affect the quality of life in ICD recipients. This study evaluated the incidence and causes of inappropriate detection and therapy by ICDs in patients in our hospital.

METHODS

From January 2000 to December 2005, fifty patients who received ICD implantation for ventricular arrhythmias for prevention of sudden cardiac death were evaluated in this study. Each ICD was programmed using clinical arrhythmic and cardiac data of the patient before discharge. Patients were followed up by standard schedule after implantation and all data retrieved from each device were collected and saved for further analysis.

RESULTS

No arrhythmic event was detected in 12/50 (24%) patients during the period of follow-up. Among the remaining patients, 11 (22%) experienced inappropriate detections and therapies during follow-up in this study. ICD detected 383 ventricular tachyarrhythmia (VT) and 108 ventricular fibrillation (VF) episodes and delivered 678 therapies. In VT group, ICD delivered 413 antitachycardiac pacings (ATPs) and 118 shocks, among which 78 ATPs and 9 shocks were initiated by 55/383 (14.3%) inappropriate detections. In VF group ICD delivered 147 shocks, among which 56 shocks were initiated by 28/108 (26.9%) inappropriate detections. Overall, more than 50% of these episodes were caused by atrial fibrillation (AF) with rapid ventricular response, followed by electromagnetic or myopotential interference. In addition, most inappropriate therapies occurred within one year after ICD implantation.

CONCLUSIONS

About one fifth of patients experienced ICD inappropriate detection and therapy after implantation. The main cause was AF with rapid ventricular response, followed by electromagnetic or myopotential interference.

摘要

背景

植入式心脏复律除颤器（ICD）是治疗危及生命的室性心律失常患者的唯一有效疗法。ICD的不恰当检测和治疗是影响ICD植入患者生活质量的最常见副作用原因。本研究评估了我院患者中ICD不恰当检测和治疗的发生率及原因。

方法

2000年1月至2005年12月，本研究对50例因室性心律失常接受ICD植入以预防心源性猝死的患者进行了评估。每个ICD在出院前根据患者的临床心律失常和心脏数据进行编程。植入后按标准时间表对患者进行随访，并收集和保存从每个设备检索到的所有数据以进行进一步分析。

结果

随访期间，12/50（24%）的患者未检测到心律失常事件。在其余患者中，11例（22%）在本研究随访期间经历了不恰当的检测和治疗。ICD检测到383次室性快速心律失常（VT）和108次心室颤动（VF）发作，并进行了678次治疗。在VT组中，ICD进行了413次抗心动过速起搏（ATP）和118次电击，其中78次ATP和9次电击由55/383（14.3%）的不恰当检测引发。在VF组中，ICD进行了147次电击，其中56次电击由28/108（26.9%）的不恰当检测引发。总体而言，这些发作中超过50%是由伴有快速心室反应的心房颤动（AF）引起的，其次是电磁或肌电位干扰。此外，大多数不恰当治疗发生在ICD植入后一年内。