Kim S G, Ling J, Fisher J D, Wang G, Rameneni A, Roth J A, Ferrick K J, Gross J, Ben-Zur U, Brodman R
Department of Medicine, Montefiore Medical Center, Bronx, New York 10467.
Am J Cardiol. 1994 Dec 15;74(12):1245-8. doi: 10.1016/0002-9149(94)90556-8.
Postoperative exacerbation of ventricular arrhythmias has been reported in some patients treated with thoracotomy implantable cardioverter-defibrillators (ICDs). This phenomenon, which may be related to epicardial patch electrodes, may be less frequent after nonthoracotomy ICD implantation. In this nonrandomized study, postoperative arrhythmias in thoracotomy approaches (n = 52) were compared with those in nonthoracotomy approaches (n = 59). Preoperatively, all patients were clinically stable receiving an antiarrhythmic regimen chosen by serial drug testing. Nine of 52 patients in the thoracotomy group developed sustained ventricular tachycardia postoperatively while receiving the same antiarrhythmic regimen chosen preoperatively, and 1 patient eventually died. Two additional patients developed frequent and prolonged episodes of nonsustained ventricular tachycardia requiring changes in the antiarrhythmic regimen. In the nonthoracotomy group, only 3 of 59 patients developed sustained ventricular tachycardia and 1 developed frequent nonsustained ventricular tachycardia. Thus, only 4 of 59 patients in the nonthoracotomy group developed clinically significant ventricular arrhythmia during the postoperative period compared with 11 of 52 patients in the thoracotomy group (p < 0.05). Surgical mortality was 6% in the thoracotomy group, and 0% in the nonthoracotomy group. In the remaining clinically stable patients, a marked (sevenfold) increase in asymptomatic ventricular arrhythmias was noted in 15 of 39 patients in the thoracotomy group, and in 3 of 55 patients in the nonthoracotomy group (p < 0.05). Thus, postoperative exacerbation of ventricular arrhythmia, sometimes noted with thoracotomy approaches, is very rare with nonthoracotomy approaches.
据报道，一些接受开胸植入式心脏复律除颤器（ICD）治疗的患者术后会出现室性心律失常加重的情况。这种现象可能与心外膜贴片电极有关，在非开胸ICD植入术后可能不太常见。在这项非随机研究中，比较了开胸植入法（n = 52）和非开胸植入法（n = 59）术后的心律失常情况。术前，所有患者临床稳定，接受通过系列药物测试选择的抗心律失常方案。开胸组的52例患者中有9例在术后接受术前选择的相同抗心律失常方案时发生持续性室性心动过速，1例最终死亡。另外2例患者出现频繁且持续时间较长的非持续性室性心动过速发作，需要改变抗心律失常方案。在非开胸组中，59例患者中只有3例发生持续性室性心动过速，1例发生频繁的非持续性室性心动过速。因此，非开胸组的59例患者中只有4例在术后出现具有临床意义的室性心律失常，而开胸组的52例患者中有11例出现（p < 0.05）。开胸组的手术死亡率为6%，非开胸组为0%。在其余临床稳定的患者中，开胸组的39例患者中有15例无症状性室性心律失常显著增加（增加了7倍），非开胸组的55例患者中有3例出现这种情况（p < 0.05）。因此，开胸植入法有时会出现的术后室性心律失常加重情况，在非开胸植入法中非常罕见。
