植入式心脏复律除颤器超过 10 年 - 60 例患者的长期随访。
Over 10 years with an implantable cardioverter-defibrillator - a long term follow-up of 60 patients.
机构信息
Institute of Cardiology, Warsaw, Poland.
出版信息
Kardiol Pol. 2010 Sep;68(9):1023-9.
BACKGROUND
Transvenous implantable cardioverter-defibrillators (ICD) have been implanted in Poland since 1995. As the method spreads it is important to consider its long-term benefits and disadvantages.
AIM
To assess survival, efficacy and complication rate in ICD patients, who received the device more than ten years earlier.
METHODS
Retrospective analysis of 60 ICD patients implanted between 1995-1999.
RESULTS
There were 42 (70%) males, mean age 50.6 ± 16.4 years. In 59 patients ICD was implanted for sudden cardiac death (SCD) secondary prevention. Thirty eight patients (34 M, 63.3%) had coronary artery disease (CAD). The CAD was diagnosed in 89.5% of males and 10.5% of females (p〈 0.0001). Mean follow-up time was 75.4 ± 34.7 months. During this time 22 patients died (37%, 19 M, 3 F). Three deaths were SCD. Mean one-year mortality was 6.7%. Deaths were more frequent among males: 45.2% vs 16.7%, p〈 0.005. In CAD mortality was higher than in non-CAD patients (50% vs 13.6%, p〈 0.005). Appropriate ICD discharges in the ventricular fibrillation (VF) zone occurred in 35 (58%) patients, and in ventricular tachycardia (VT) zone - in 26 (43%) patients. Mean intervention rate per year was 3.7 for VF and 0.6 for VT. Complications occurred in 27 (45%) patients and 5 (8%) of them had no ICD intervention during follow-up. In 5 patients more than one complication was diagnosed. There were inappropriate discharges in 15 (25%) patients, 11 (18%) had electrical storm, and ICD-related infections were noted in 3 (5%) patients. During the perioperative period, lead revisions were done in 4 patients; in 3 with discharges induced by T-wave oversensing and in one with lead dislocation. Four cases of lead failure occurred during follow-up, requiring new lead implantation. In 4 patients, electrical storm (3 patients) and supraventricular tachycardia with ICD discharges (1 patient) were treated with radiofrequency ablation. Only 10 (17%) patients did not demonstrate any ICD interventions or ICD-related complications.
CONCLUSIONS
- ICD interventions caused by malignant ventricular arrhythmias occurred in 75% patients with the device implanted more than 10 years earlier. 2. Almost a half of the analysed population suffered from complications and side effects related to implanted ICD and they were present in 8% of subjects without ICD intervention. Neither ICD interventions nor device-related adverse events were recorded in 17% of patients.
背景
自 1995 年以来，波兰已经植入了经静脉植入式心脏复律除颤器（ICD）。随着该方法的普及，重要的是要考虑其长期的益处和弊端。
目的
评估在 10 年前植入 ICD 的患者的生存率、疗效和并发症发生率。
方法
回顾性分析了 1995 年至 1999 年间植入的 60 例 ICD 患者。
结果
42 例（70%）为男性，平均年龄 50.6±16.4 岁。59 例患者因心脏性猝死（SCD）二级预防而植入 ICD。38 例（34 例男性，63.3%）患有冠状动脉疾病（CAD）。CAD 在男性中的诊断率为 89.5%，在女性中的诊断率为 10.5%（p<0.0001）。平均随访时间为 75.4±34.7 个月。在此期间，22 例患者死亡（37%，19 例男性，3 例女性）。3 例死亡为 SCD。一年死亡率平均为 6.7%。男性死亡率更高：45.2%对 16.7%，p<0.005。CAD 患者的死亡率高于非 CAD 患者（50%对 13.6%，p<0.005）。35 例（58%）患者在室颤（VF）区发生了适当的 ICD 放电，26 例（43%）患者在室性心动过速（VT）区发生了适当的 ICD 放电。VF 每年的平均干预率为 3.7，VT 为 0.6。27 例（45%）患者出现并发症，5 例（8%）患者在随访期间未进行 ICD 干预。5 例患者诊断出多种并发症。15 例（25%）患者发生不适当放电，11 例（18%）患者发生电风暴，3 例（5%）患者发生与 ICD 相关的感染。在围手术期，对 4 例患者进行了导联修订；在 3 例因 T 波过感知而引发放电的患者中，以及在 1 例因导联脱位而引发放电的患者中进行了导联修订。在随访期间，4 例发生导联故障，需要植入新的导联。在 4 例患者中，电风暴（3 例）和 ICD 放电相关的室上性心动过速（1 例）用射频消融治疗。只有 10 例（17%）患者未发生任何 ICD 干预或与 ICD 相关的并发症。
结论
- 在 10 年前植入 ICD 的患者中，75%的患者因恶性室性心律失常而发生 ICD 干预。2. 分析人群中近一半的人患有与植入 ICD 相关的并发症和副作用，在 8%的无 ICD 干预的患者中存在这些并发症和副作用。17%的患者未记录到任何 ICD 干预或与设备相关的不良事件。
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