Watson J, Smith V, Schmidt D, Navratil D
Section of Cardiothoracic Surgery, Wilford Hall USAF Medical Center, Lackland AFB, TX 78236-5300.
South Med J. 1992 Feb;85(2):161-3.
Fifteen patients with malignant ventricular arrhythmias were treated with the automatic implantable cardioverter-defibrillator (AICD) over a 22-month period. The cause of the arrhythmia was coronary artery disease in 13 of the patients (87%), sarcoid cardiomyopathy in one (7%), and a primary electrical abnormality in one (7%). The mean ejection fraction was 29%, with a range of 15% to 70%. Fourteen of the patients had inducible ventricular tachycardia using program stimulation. Defibrillating and rate-sensing leads were inserted through a lateral thoracotomy in 13 patients and through a median sternotomy in two patients in conjunction with other cardiac procedures. The generators were positioned in a subcutaneous pocket beneath the left costal cartilage. There was one early and one late death, both due to congestive heart failure. Neither was related to a ventricular tachyarrhythmia, and in each patient the AICD was functioning properly at the time of death. The mean follow-up period was 11.5 months, with five patients receiving a total of 17 shocks. We conclude that the AICD is a highly effective, low-risk treatment for malignant ventricular tachyarrhythmias.
在22个月的时间里，15例恶性室性心律失常患者接受了植入式自动心脏复律除颤器（AICD）治疗。心律失常的病因在13例患者（87%）中为冠状动脉疾病，1例（7%）为结节病性心肌病，1例（7%）为原发性电异常。平均射血分数为29%，范围为15%至70%。14例患者通过程序刺激可诱发室性心动过速。13例患者通过侧胸壁切开术插入除颤和心率感知电极，2例患者在进行其他心脏手术时通过正中胸骨切开术插入。发生器置于左肋软骨下方的皮下囊袋中。有1例早期死亡和1例晚期死亡，均因充血性心力衰竭。两者均与室性快速心律失常无关，且在每名患者死亡时AICD均功能正常。平均随访期为11.5个月，5例患者共接受了17次电击。我们得出结论，AICD是治疗恶性室性快速心律失常的一种高效、低风险的治疗方法。
