Prasad K, Kishore A G, Anderson M H, Ward D E, Rowland E, Gill J S, Camm A J
Department of Cardiological Sciences, St. George's Hospital Medical School, London.
Indian Heart J. 1997 Jul-Aug;49(4):403-7.
Implantation of internal cardioverter defibrillators (ICDs) for treatment of malignant ventricular arrhythmias is complicated by failure of therapy or inappropriate shocks. We studied 81 patients (age range 16-72 years; mean 48 +/- 13 years) who underwent ICD implantation for device therapy. The underlying aetiology was ischaemic heart disease (39%), cardiomyopathies (32%) and others (28%). Information regarding shocks was collected using Holter monitoring, telemetry or device memory (stored electrograms) and lastly by clinical follow-up. Fifty-eight patients completed 36 months of follow-up. Thirty-five patients experienced 337 spontaneous shocks, appropriate in 21, inappropriate in 12, and both in two patients. Of the 74 episodes of inappropriate discharges for rhythms other that ventricular tachycardia (VT) or ventricular fibrillation(VF), 55 percent were due to supraventricular arrhythmias (atrial flutter or fibrillation). Lead malfunction occurred in four and the device was replaced in two. Additional drugs controlled AF in one. There was no mortality in any of the 81 patients. The frequency of shocks was highest in the first six months after implantation and atrial fibrillation remains the main cause. In conclusion, inappropriate shocks are frequent in patients undergoing ICD implantation.
植入式心脏复律除颤器（ICD）用于治疗恶性室性心律失常时，会出现治疗失败或不适当电击等并发症。我们研究了81例接受ICD植入以进行器械治疗的患者（年龄范围16 - 72岁；平均48±13岁）。潜在病因包括缺血性心脏病（39%）、心肌病（32%）和其他（28%）。通过动态心电图监测、遥测或器械存储器（存储的心电图）收集有关电击的信息，最后通过临床随访收集。58例患者完成了36个月的随访。35例患者经历了337次自发电击，其中21次合适，12次不合适，2例患者两者皆有。在74次因非室性心动过速（VT）或室颤（VF）节律而进行的不适当放电中，55%是由于室上性心律失常（心房扑动或颤动）。4例发生导线故障，2例更换了器械。1例患者加用其他药物控制房颤。81例患者均无死亡。电击频率在植入后的前六个月最高，房颤仍然是主要原因。总之，接受ICD植入的患者中不适当电击很常见。
