Gartman D M, Bardy G H, Allen M D, Misbach G A, Ivey T D
Department of Surgery, University of Washington, Seattle 98195.
J Thorac Cardiovasc Surg. 1990 Sep;100(3):353-7; discussion 357-9.
Over the 3-year period from Jan. 1, 1986, through Dec. 31, 1988, we have implanted 101 automatic implantable cardioverter-defibrillators into patients with life-threatening ventricular arrhythmias. There were 82 male patients and 19 female patients. The mean age was 58 years with a range of 25 to 82 years. The indication for implantation was ventricular fibrillation in 89 patients and recurrent ventricular tachycardia in 12 patients. Seventy-seven patients had a history of prior myocardial infarction or coronary artery disease, or both. Eighteen patients had nonischemic cardiomyopathy. One patient had a prolonged QT syndrome and five patients had no evidence of preexisting structural heart disease. The mean injection fraction was 37% +/- 17%. Forty-one of the automatic implantable cardioverter-defibrillator implantations were associated with procedures necessitating cardiopulmonary bypass. The hospital mortality rate was 4% and the morbidity rate was 15%. The only statistical difference between those patients who did and did not have postoperative complications was a history of a prior myocardial infarction (90% versus 54%, p less than 0.05). Twenty percent of patients had new-onset postoperative atrial fibrillation after implantation of the device. Eleven percent of patients had sustained ventricular tachycardia postoperatively. Although there was a trend toward a higher complication/death rate in the patients whose automatic implantable cardioverter-defibrillator was inserted in association with cardiopulmonary bypass (24% versus 15%) and the occurrence of new-onset postoperative atrial fibrillation (27% versus 15%), these findings were not statistically significant. Automatic implantable cardioverter-defibrillator implantation with and without concomitant cardiopulmonary bypass is associated with a clinically important morbidity and mortality rate and development of postoperative arrhythmias.
在1986年1月1日至1988年12月31日的3年期间，我们为患有危及生命的室性心律失常的患者植入了101台自动植入式心脏复律除颤器。其中男性患者82例，女性患者19例。平均年龄为58岁，范围在25至82岁之间。植入的适应症为89例患者的心室颤动和12例患者的复发性室性心动过速。77例患者有既往心肌梗死或冠状动脉疾病史，或两者兼有。18例患者患有非缺血性心肌病。1例患者患有长QT综合征，5例患者无既往结构性心脏病证据。平均射血分数为37%±17%。41例自动植入式心脏复律除颤器植入与需要体外循环的手术相关。医院死亡率为4%，发病率为15%。有和没有术后并发症的患者之间唯一的统计学差异是既往心肌梗死病史（90%对54%，P<0.05）。20%的患者在植入装置后出现新发术后房颤。11%的患者术后出现持续性室性心动过速。尽管在与体外循环相关的自动植入式心脏复律除颤器植入患者中并发症/死亡率有升高趋势（24%对15%）以及新发术后房颤的发生率（27%对15%），但这些结果无统计学意义。无论是否伴有体外循环，自动植入式心脏复律除颤器植入都与具有临床重要性的发病率、死亡率以及术后心律失常的发生相关。
