Thomas O, Leenhardt A, Masquet C, Leclercq J F, Slama M, Ménasché P, Coumel P, Slama R
Clinique cardiologique, hôpital Lariboisière, Paris.
Arch Mal Coeur Vaiss. 1994 Jul;87(7):931-5.
The authors report three cases of pericardial constriction secondary to implantation of an automatic defibrillator. In one case, the pericardial constriction occurred 1 year after implantation and was associated with ascending infection of the patch electrodes from the stimulator; the patient died when the patch electrodes were removed, the infection having eroded the left ventricular wall. In the other two cases, signs of constriction appeared 2 years after implantation. In one of these patients, surgery showed a fibrous pericardial reaction deforming the patch electrodes with a favourable outcome when the electrodes were removed. The other patient refused surgery. In the three cases, the diagnosis was confirmed by right heart catheterisation and ventriculography which showed signs of adiastole and severe deformation of the ventricular contours. Pericardial constriction due to patch electrodes is a potentially serious complication of implantable automatic defibrillators, the prevalence of which may be underestimated. The use of endocavitary or extra-pericardial electrodes should avoid this complication.
作者报告了3例因植入自动除颤器继发心包缩窄的病例。1例心包缩窄发生在植入后1年，与刺激器的贴片电极上行感染有关；移除贴片电极时患者死亡，感染已侵蚀左心室壁。另外2例缩窄迹象出现在植入后2年。其中1例患者手术显示纤维性心包反应使贴片电极变形，移除电极后效果良好。另1例患者拒绝手术。3例均经右心导管检查和心室造影确诊，显示舒张期征象和心室轮廓严重变形。贴片电极导致的心包缩窄是植入式自动除颤器潜在的严重并发症，其发生率可能被低估。使用心腔内或心包外电极应可避免此并发症。
