Adragão P, Parreira L, Neves J, Morgado F, Abecassis M, Almeida M, Martins D, Bonhorst D, Seabra-Gomes R
Departamento de Arritmologia, Hospital de Santa Cruz.
Rev Port Cardiol. 1996 Mar;15(3):195-206, 179, 181.
The aim of this study was to evaluate the results of our experience with implantable cardioverter-defibrillator therapy.
We treated with implantable cardioverter-defibrillator (ICD) 18 patients, 15 male and 3 female, mean age 51 years, ranging from 12 to 76 years, with life threatening ventricular arrhythmias. Eleven patients were resuscitated from cardiac arrest and seven had refractory ventricular tachycardia. The underlying condition was coronary artery disease in 12 patients, dilated cardiomyopathy in two, congenital long QT syndrome in one, mitral regurgitation in one and idiopathic in two patients.
All patients underwent cardiac catheterization and electrophysiological study before ICD implantation. In the first patient epicardial leads were used, but a transvenous approach was used in the remaining 17 patients. The device was implanted in an abdominal position in all patients. Defibrillation and pacing threshold tests were performed during the implantation procedure and whenever necessary. After implantation, patients were followed up in an outpatient basis, with evaluation of therapy efficacy and reprogramming of the device if required. The mean follow-up time was 16 months, ranging from 1 to 40 months.
The implantation was successful and without complications in all patients. Defibrillation threshold was considered within normal range, with an electrode impedance ranging from 40 to 65 Ohms. During the follow-up period no deaths occurred, 8 patients (44%) had episodes of VT or VF that were successfully treated, with shock in six patients, with antitachycardia pacing in one and with both modalities in another patient. Inappropriate shocks were observed in three patients (16%). The device was reprogrammed in five patients.
Our experience with implantable ICD in patients who survived cardiac arrest or with refractory VT has shown a low surgical risk with no mortality. The incidence of ICD discharges was high, with a satisfactory efficacy rate and the number of inappropriate shocks was acceptable. The careful patient selection made possible a good cost/benefit relation.
本研究旨在评估我们在植入式心脏复律除颤器治疗方面的经验结果。
我们对18例患者进行了植入式心脏复律除颤器（ICD）治疗，其中男性15例，女性3例，平均年龄51岁，年龄范围为12至76岁，均患有危及生命的室性心律失常。11例患者曾从心脏骤停中复苏，7例患有难治性室性心动过速。基础疾病为冠状动脉疾病12例，扩张型心肌病2例，先天性长QT综合征1例，二尖瓣反流1例，特发性2例。
所有患者在植入ICD前均接受了心脏导管检查和电生理研究。首例患者使用了心外膜导联，但其余17例患者采用了经静脉途径。所有患者的设备均植入腹部位置。在植入过程中及必要时进行除颤和起搏阈值测试。植入后，对患者进行门诊随访，评估治疗效果，并在需要时对设备进行重新编程。平均随访时间为16个月，范围为1至40个月。
所有患者植入均成功且无并发症。除颤阈值被认为在正常范围内，电极阻抗范围为40至65欧姆。随访期间无死亡发生，8例患者（44%）发生室性心动过速（VT）或心室颤动（VF）发作并得到成功治疗，其中6例接受了电击治疗，1例接受了抗心动过速起搏治疗，另1例同时接受了两种治疗方式。3例患者（16%）出现了不适当电击。5例患者的设备进行了重新编程。
我们在心脏骤停存活者或难治性VT患者中使用植入式ICD的经验表明，手术风险低且无死亡率。ICD放电发生率高，疗效令人满意，不适当电击次数可接受。精心的患者选择使得成本效益关系良好。
