Bolling S F, Deeb G M, Morady F, Kadish A, Stirling M C, deBuitleir M, Kirsh M M
Section of Thoracic Surgery, University of Michigan Medical Center, Ann Arbor.
J Heart Lung Transplant. 1991 Jul-Aug;10(4):562-6.
The automatic internal cardioverter defibrillator (AICD) is effective in preventing death in patients with malignant ventricular arrhythmias (VT/VF) refractory to medical therapy. Because of the long waiting period for heart transplantation and the high likelihood of sudden arrhythmic death in this population, this study was undertaken to assess the value of the AICD in patients awaiting heart transplantation who have refractory VT/VF. Fourteen patients awaiting heart transplantation who had a history of VT/VF underwent AICD implantation (10 extrapericardial and four intrapericardial) via median sternotomy. All patients survived the AICD implantation and have either had heart transplantation or await transplantation at present (1 to 24 months after AICD implantation). Twelve of these patients have received a mean of 10 AICD shocks (range, 0 to 32). One patient received 19 shocks in the 24-hour period before transplantation. Two patients have died of progressive heart failure. Five patients have gone on to successful transplantation, and seven patients await heart transplantation with a functioning AICD in place. In conclusion, the AICD represents a new "bridge" to heart transplantation that is well tolerated by these high-risk patients, avoids drug side effects, and is efficacious in aborting sudden death, thereby allowing them to undergo successful heart transplantation.
自动体内心脏复律除颤器（AICD）对于预防药物治疗无效的恶性室性心律失常（室速/室颤）患者死亡有效。鉴于心脏移植等待期较长且该人群发生心律失常性猝死的可能性较高，本研究旨在评估AICD对于等待心脏移植且患有难治性室速/室颤患者的价值。14例有室速/室颤病史且等待心脏移植的患者通过正中胸骨切开术接受了AICD植入（10例心包外植入，4例心包内植入）。所有患者均在AICD植入后存活，目前已接受心脏移植或仍在等待移植（AICD植入后1至24个月）。其中12例患者平均接受了10次AICD电击（范围为0至32次）。1例患者在移植前24小时内接受了19次电击。2例患者死于进行性心力衰竭。5例患者已成功接受移植，7例患者在AICD功能正常的情况下等待心脏移植。总之，AICD是通往心脏移植的一种新“桥梁”，这些高危患者对其耐受性良好，可避免药物副作用，且能有效中止猝死，从而使他们能够成功接受心脏移植。
