Elefteriades J A, Biblo L A, Batsford W P, Rosenfeld L E, Henthorn R W, Carlson M D, Waldo A L, Hsu J, Geha A S
Section of Cardiothoracic Surgery, Yale University School of Medicine, New Haven, Connecticut 06510.
Ann Thorac Surg. 1990 Jan;49(1):94-100. doi: 10.1016/0003-4975(90)90362-a.
The advent of the automatic implantable cardioverter defibrillator (AICD), generally viewed as a safe and effective intervention, has in some measure discouraged the use of electrophysiologically directed endocardial resection for intractable ventricular arrhythmias. We reviewed the records of 127 patients undergoing either AICD procedures or resection over a 6-year period. Thirty-day mortality was 5.6% (5/89 patients) for all AICD procedures, 10.7% (3/28) for AICD placement plus coronary artery bypass grafting, and 11.8% (4/34) for resection. These mortality figures are not significantly different. Patients undergoing resection were less likely to require antiarrhythmic agents than patients given an AICD (33% versus 61%). Survival at 2 years was 78% in the resection group and 72% in the AICD group. Survival at 4 years was still 78% in the resection group. Only 1 late sudden death occurred in the AICD group and none in the resection group. We conclude that resection continues to be a valuable alternative, offering a greater overall benefit at only slightly increased risk.
植入式自动心脏复律除颤器（AICD）的出现，通常被视为一种安全有效的干预措施，在一定程度上抑制了针对顽固性室性心律失常的电生理导向心内膜切除术的使用。我们回顾了127例在6年期间接受AICD手术或切除术的患者的记录。所有AICD手术的30天死亡率为5.6%（89例患者中的5例），AICD植入加冠状动脉旁路移植术的30天死亡率为10.7%（28例中的3例），切除术的30天死亡率为11.8%（34例中的4例）。这些死亡率数字没有显著差异。与接受AICD的患者相比，接受切除术的患者需要抗心律失常药物的可能性较小（33%对61%）。切除术组的2年生存率为78%，AICD组为72%。切除术组的4年生存率仍为78%。AICD组仅发生1例晚期猝死，切除术组无晚期猝死发生。我们得出结论，切除术仍然是一种有价值的替代方法，在风险仅略有增加的情况下能提供更大的总体益处。
