植入式心脏复律除颤器治疗的儿童和青年的长期随访：作者在优化植入式心脏复律除颤器编程方面的经验。

Long-term follow-up of children and young adults treated with implantable cardioverter-defibrillator: the authors' own experience with optimal implantable cardioverter-defibrillator programming.

机构信息

The National Institute of Cardiology, Warsaw, Poland.

出版信息

Europace. 2010 Sep;12(9):1245-50. doi: 10.1093/europace/euq263. Epub 2010 Jul 21.

DOI:10.1093/europace/euq263

PMID:20650939

Abstract

AIMS

Young implantable cardioverter-defibrillator (ICD) recipients present a high rate of inappropriate interventions. Some of them are caused by suboptimal pre-discharge programming of the device. There are conflicting data as regards antitachycardia pacing (ATP) effectiveness in children and young adults. We report our experience with ICD programming and a rate of complications during a 10 year follow-up.

METHODS AND RESULTS

We analysed the use and effectiveness of ATP and complications rate in 63 patients aged 6-21 years. Antitachycardia pacing (burst or ramp) was programmed ON in 14 patients (22%), 49 patients (78%) had only ventricular fibrillation (VF) therapy when discharged after implantation. The incidence of effective vs. ineffective or harmful ATP therapy: 5% of patients vs. 19% of patients differed significantly (P < 0.05). Fourteen patients (22%) received > or =1 appropriate shock(s) for ventricular tachycardia/VF and 17 patients (27%) had one or multiple inappropriate therapy (IT). Inappropriate therapy resulted from T-wave over-sensing (nine patients), sinus tachycardia (three patients), fast atrial fibrillation (five patients), and lead insulation disruption (1%). Reprogramming of the device eliminated IT in all cases. There were 13 (21%) surgical complications. Serious psychological sequelae developed in 27 (43%) patients. There was one death during the follow-up period.

CONCLUSION

Antitachycardia pacing therapy is rarely effective and often harmful in young ICD recipients. In most patients, programming ICD for only VF therapy is sufficient. Routine pre-discharge programming against inappropriate interventions (especially T-wave over-sensing) helps to reduce the incidence of discharges during the follow-up. The incidence of complications and inappropriate therapies is high in young ICD recipients and affects 50% of patients.

摘要

目的

年轻的植入式心脏复律除颤器 (ICD) 受者发生不适当干预的比率较高。其中一些是由于设备的出院前程控不佳引起的。关于儿童和年轻成人的抗心动过速起搏 (ATP) 效果存在相互矛盾的数据。我们报告了我们在 ICD 编程方面的经验以及 10 年随访期间的并发症发生率。

方法和结果

我们分析了 63 名年龄在 6-21 岁的患者的 ATP 使用情况和有效性以及并发症发生率。14 名患者（22%）程控 ATP 为开启，49 名患者（78%）植入后出院时仅具有心室颤动 (VF) 治疗。有效 ATP 治疗与无效或有害 ATP 治疗的发生率：5%的患者与 19%的患者有显著差异（P < 0.05）。14 名患者（22%）因室性心动过速/VF 接受了>或=1 次适当的电击，17 名患者（27%）发生了 1 次或多次不适当的治疗（IT）。不适当的治疗是由 T 波过感知（9 名患者）、窦性心动过速（3 名患者）、快速心房颤动（5 名患者）和导联绝缘破坏（1 名患者）引起的。所有病例均通过重新编程设备消除了 IT。有 13 例（21%）手术并发症。27 名患者（43%）出现严重心理后遗症。随访期间有 1 例死亡。