Tsuji H, Shahian D M, Venditti F J
Section of Cardiology, Lahey Clinic Medical Center, Burlington, Massachusetts.
Jpn Circ J. 1991 Jul;55(7):669-75. doi: 10.1253/jcj.55.669.
Forty patients (36 men and 4 women) with life-threatening arrhythmia received an implantable cardioverter defibrillator (ICD). Mean age was 63 years (range, 46 to 80 years). All patients had structural heart disease, with coronary artery disease in 32 patients, idiopathic cardiomyopathy in 7 patients, and hypertensive heart disease in 1 patient. Mean left ventricular ejection fraction was 29 +/- 13%. The clinical arrhythmia was out-of-hospital cardiac arrest in 14 patients (35%), symptomatic sustained ventricular tachycardia in 21 patients (53%), and episodes of syncope without documented spontaneous ventricular arrhythmia but ventricular tachycardia that was easily provoked at the time of electrophysiologic testing in 5 patients (13%). Sustained ventricular tachycardia was induced in 37 patients (93%) at basic electrophysiologic testing. The average number of drug failures was 2.9 +/- 1.4 per patient. One patient (2.5%) died perioperatively because of intractable ventricular tachycardia and ventricular fibrillation. During a median follow-up period of 5.5 months (range 2-21 months) 2 sudden deaths occurred. No patient had a serious complication during the follow-up period. Ten patients (25%) received antiarrhythmic drugs to suppress spontaneous ventricular tachycardia. Appropriate shock treatment was received by 18 patients (45%), and inappropriate shock treatment was received by 2 patients (5%). Several issues regarding use of the ICD must be considered, but the device seems to be useful, and it is associated with an acceptable rate of complications and good long-term success at the present time.
40例有危及生命心律失常的患者（36例男性，4例女性）接受了植入式心脏复律除颤器（ICD）治疗。平均年龄63岁（范围46至80岁）。所有患者均有结构性心脏病，其中32例患有冠状动脉疾病，7例患有特发性心肌病，1例患有高血压性心脏病。平均左心室射血分数为29±13%。临床心律失常情况为：14例患者（35%）发生院外心脏骤停，21例患者（53%）出现有症状的持续性室性心动过速，5例患者（13%）出现无记录的自发性室性心律失常但在电生理检查时容易诱发室性心动过速的晕厥发作。在基础电生理检查中，37例患者（93%）诱发出持续性室性心动过速。每位患者平均药物治疗失败次数为2.9±1.4次。1例患者（2.5%）围手术期因顽固性室性心动过速和心室颤动死亡。在中位随访期5.5个月（范围2至21个月）内发生了2例猝死。随访期间无患者出现严重并发症。10例患者（25%）接受抗心律失常药物以抑制自发性室性心动过速。18例患者（45%）接受了适当的电击治疗，2例患者（5%）接受了不适当的电击治疗。关于ICD的使用必须考虑几个问题，但目前该装置似乎是有用的，并且其并发症发生率可接受，长期成功率良好。
