Paul T, Luhmer I, Trappe H J, Klein H, Fieguth H G, Brauer C, Scharpwinkel U, Kallfelz H C
Abteilung Kinderheilkunde III, Medizinische Hochschule Hannover.
Z Kardiol. 1993 Aug;82(8):466-73.
Little experience exists with the automatic implantable cardioverter-defibrillator in the pediatric population. Since 1990, an automatic implantable cardioverter defibrillator was implanted in four young patients (mean age 15.8 years, mean body weight 53.3 kg) with life-threatening ventricular tachyarrhythmias at our institution. In three patients, a cardiac anomaly was evident (dilated cardiomyopathy, status post Rastelli operation for complex transposition of the great arteries, status post atrial switch for transposition of the great arteries), the last patient had a normal cardiac anatomy. Indications for implantation were resuscitation from documented hypotensive ventricular tachycardia in one patient and recurrent syncope of suspected cardiac origin in the remaining three patients. At preimplantation electrophysiological study, all four patients had inducible ventricular tachycardia and/or ventricular fibrillation. At implantation of the cardioverter defibrillator in the operating theatre, the ventricular tachyarrhythmias were again induced and terminated reliably by the device. After a mean follow-up of 13 months, three of the four patients had appropriate discharges without syncope or resuscitation. The automatic implantable cardioverter-defibrillator appears to be a feasible and effective therapy also in pediatric patients for prevention of sudden cardiac death due to ventricular tachyarrhythmias.
在儿科人群中，可植入式自动心脏复律除颤器的应用经验较少。自1990年以来，我们机构为4名患有危及生命的室性快速心律失常的年轻患者（平均年龄15.8岁，平均体重53.3千克）植入了可植入式自动心脏复律除颤器。其中3例患者存在明显的心脏异常（扩张型心肌病、大动脉复杂转位行Rastelli手术后状态、大动脉转位行心房调转术后状态），最后1例患者心脏解剖结构正常。植入指征为1例患者经记录的低血压性室性心动过速复苏成功，其余3例患者有疑似心脏源性反复晕厥。在植入前的电生理研究中，所有4例患者均可诱发出室性心动过速和/或室颤。在手术室植入心脏复律除颤器时，再次诱发出室性快速心律失常，并被该装置可靠终止。平均随访13个月后，4例患者中有3例进行了适当的电击，且未发生晕厥或需要复苏。可植入式自动心脏复律除颤器对于预防儿科患者因室性快速心律失常导致的心源性猝死似乎也是一种可行且有效的治疗方法。
