重视植入型心律转复除颤器无痛性治疗

接受了植入型心律转复除颤器(ICD)治疗的患者一旦发生了室性心动过速(VT),ICD将给予正确识别并治疗,治疗中非常重要的一部分是给予ICD的正确放电治疗,但是即使是正确的放电治疗也会给患者带来痛苦,不但影响患者生活质量、减少ICD电池寿命,更重要的是影响患者预后.因此,近年来提倡ICD的无痛性治疗,即对于VT尽可能采用抗心动过速起搏(ATP)来终止心律失常,即使对于频率较快的VT也提倡首先尝试ATP治疗,只有在ATP治疗失败后再给予放电治疗,这样可以明显减少患者的ICD放电次数.国外进行了多项临床试验以确定减少ICD放电的可行性及安全性.     

皮下植入型心律转复除颤器治疗现状

心脏性猝死(sudden cardiac death,SCD)是指在非常短的时间里(通常在症状发生后1 h以内)由于心脏原因发生的意外死亡,大多数情况下患者猝死前未发现伴有致命性的疾病。突发病情以及高死亡率一直是SCD的两大特点。Framingham长达26年的研究显示:猝死人数约占总死亡人数的13%。80%的SCD由心室颤动(VF)或室性心动过速(VT)引     

植入型心律转复除颤器治疗的适应证

致命性室性心律失常（室性心动过速／心室颤动）是心脏性猝死（SCD）的主要原因，美国每年约40万人死于此症。一系列多中心临床试验证明ICD是优于药物的有效治疗方法，明显降低SCD发生率。美国每年上万人安装ICD，其数量呈直线上升趋势。我国由于经济条件和认识水平普及的限制，采用ICD治疗的患者甚少，但近年来逐渐增多，1年约100例患者安装ICD。为提高医生和患者对应用ICD的认识及使用规范化，两个学会的ICD专家组于2001年11月在北京召开研讨会，就ICD适应证、多中心试验结果、植入技术、心动过速的识别和治疗、并发症、随诊等专题，结合我国实际情况，进入了深入和认真的讨论，并提出建议。     

植入型心律转复除颤器治疗快速心律失常

１９８０年２月，Ｍｉｒｏｗｓｋ首次为一位心脏骤停幸存者应用植入型心律转复除颤器（ＩＣＤ）的最早产品ＡＩＤ（植入型自动除颤器，ａｕｔｏｍａｔｉｃｉｍｐｌａｎｔａｂｌｅｄｅｆｉｂｒｉｌａｔｏｒ）治疗取得成功。１９年来，ＩＣＤ的设计不断完善，功能日益复杂精...     

植入型心律转复除颤器的护理

恶性心律失常,尤其是持续性室性心动过速（VT）、心室颤动（VF）均是发生心源性猝死（suddencardiac death,SCD）的主要原因,且多发生在院外,约占心源性猝死的87％。植入型心律转复除颤器（ICD）可及时识别并有效终止恶性室性心律失常的发作,降低SCD的发生率,其疗效明显优于单纯抗心律失常药物治疗,现已成为临床预防恶性心律失常的重要手段,最终的目的是降低死亡率,已成为SCD一二级预防的最有效方法。     

植入型心律转复除颤器心室率稳定功能应用两例

长QT综合征以严重心律失常如尖端扭转性室性心动过速(室速)和心室颤动(室颤)为主要表现,严重时可导致猝死,是心脏性猝死的重要原因之一,故及时诊断和治疗极为重要.现报道两例长QT综合征患者在药物治疗基础上加用植入型心律转复除颤器( ICD)预防恶性心律失常和猝死的经验.     

植入型心律转复除颤器临床应用

目的　观察 5例恶性室性心律失常患者植入型心律转复除颤器 (ICD)植入术及临床随访情况。方法　 5例因反复发作有血流动力学障碍的室性心动过速 /心室颤动 (VT/ VF)均顺利植入 ICD(其中双腔 ICD2例 ) ,随访 6～ 2 4个月 ,观察患者临床疗效及 ICD工作情况。结果　 5例患者无 1例死亡。随访期间共出现 VT/ VF事件 30 4次 ,ICD识别并治疗的 VT/ VF事件 71次 ,VT 6 5次 ,占 91.5 % ,VF 6次 ,占 8.5 % ,抗心动过速起搏 (ATP)终止 5 5次 ,占77.5 % ,心律转复 (CV)终止 16次 ,占 2 2 .5 % ,VF经除颤 (DF)全部一次成功。结论　 ICD的治疗效果肯定 ,需加强随访 ,及时修改参数 ,同时应加强药物的辅助治疗 ,如 β-受体阻断剂 ,胺碘酮等 ,积极改善心功能。     

植入型心律转复除颤器发展简史

继发于室性快速心律失常的心脏性猝死(sudden cardiac death)是医疗保健方面的一个大问题。冠心病尤其心肌梗塞(MI)后的死亡患者中，2／3死于心脏性猝死。其它器质性心脏病如心肌病和心脏瓣膜病患者，心脏性猝死的发生率也颇高。     

植入型心律转复除颤器导线故障分析

目的总结分析我院植入型心律转复除颤器（ICD）起搏除颤导线故障病例特点。方法对2005年10月至2009年12月62例在我院新植入ICD导线患者进行随访分析,所有导线植入均以锁骨下静脉作为入路。随访中出现以下1项或多项异常考虑导线故障：（1）起搏阻抗永久性或间歇性〉2000n或〈250Q;（2）除颤高压阻抗〉200n;（3）心内电图证实除颤导线感知非生理性高频噪声导致误放电。结果中位数随访时间28（10～46）个月,4例患者（6．5％）诊断ICD导线故障,导线寿命18～38个月;临床均以ICD误放电至医院就诊,同时程控发现ICD导线起搏阻抗异常。其中1例患者放电前闻及ICD导线阻抗报警,4例患者均重新植入新的起搏感知导线。结论ICD导线故障是一个值得重视的临床问题。ICD导线阻抗报警功能可能有助于早期发现导线故障。如程控发现仅仅除颤导线起搏阻抗异常,植入新的起搏感知导线可以作为首选的故障处理方法。     

植入型心律转复除颤器治疗34例随访

目的:对我院37例安装植入型心律转复除颤器患者中34例长期随访(3例失访)。方法:将随访结果进行回顾性总结分析。结果:随访时间4～69个月,平均(24.7±18)个月。29例成功接受植入型心脏复律除颤器(ICD)治疗,占全部患者的85.3%。共发作恶性室性心律失常事件587次,其中313次为非持续性,均自行终止。接受ICD治疗的274次中室性心动过速(VT)238次,占86.9%。心室颤动(VF)36次,占13.1%。VT由抗心动过速起搏(ATP)终止212次,由低能量(2～15J)转复终止23次。有3次VT在ATP治疗时转为VF,由高能量除颤(DF)终止。VF经高能量除颤36次,全部一次成功。5例患者因房性心动过速(房速)或心房颤动(房颤)被误识别为VT而发放电击。34例中有3例死亡,1例死于急性心肌梗死,1例死于心力衰竭,1例死因不明。结论:ICD可以有效的终止VT、VF,是防治心源性猝死的有效治疗手段。     

Implantable cardioverter defibrillators in heart failure.

Implantable cardioverter defibrillators provide effective and reliable treatment of spontaneous VT and VF. These devices can be expected to decrease the risk for arrhythmic death in patients with heart failure but do not improve overall survival when death from severe pump dysfunction is imminent. Appropriate patient selection is a major aspect of arrhythmia management. Future devices will incorporate features that have the potential to reduce atrial arrhythmias, improve ventricular function, monitor hemodynamics, and prevent sudden arrhythmic death.     

Implantable cardioverter defibrillators: function and troubleshooting

As a result of large, multicenter trials supporting ICDs for prevention of sudden cardiac arrest, there has been an exponential increase in ICD device therapy. Cardiologists and general practitioners are increasingly faced with the challenge to evaluate and troubleshoot device problems. In this review, we provide an overview of basic ICD function and malfunction and show examples of common ICD problems and troubleshooting.     

Implantable cardioverter defibrillators and cardiac resynchronisation therapy

Implantable cardioverter defibrillators and cardiac resynchronisation therapy (CRT) have become standard of care in modern treatment for heart failure. Results from trials have provided ample evidence that CRT, in addition to its proven benefits in patients with symptomatic heart failure (New York Heart Association [NYHA] class III), might also reduce morbidity and mortality in those with mildly symptomatic heart failure (NYHA class II). As a result, the 2010 European Society of Cardiology guidelines now recommend CRT for both patient populations. In this review we summarise and critically assess the landmark randomised clinical trials REVERSE, MADIT-CRT, and RAFT. Furthermore, we discuss the rationale and available evidence for other emerging indications of CRT, including its use in patients with a mildly reduced left ventricular ejection fraction (>35%), in those with a narrow QRS complex (≤120 ms), and in those with concomitant bradyarrhythmic pacemaker indications. We also focus on patients who do not respond to CRT, and on CRT optimisation.     

Implantable cardioverter defibrillators in pediatric patients: results in a series of 33 cases

Implantable defibrillator is the recognized treatment of sudden cardiac death. Miniaturization of the devices allows implantation in children. METHODS: This multicentric retrospective study analyzed data of 33 children aged 18 years and less who were implanted from 1990 to 2005. RESULTS: Age of patients are 10 to 18 years, 20 patients were implanted after a resuscitation of sudden death, 10 after a syncope, 2 after a ventricular tachycardia and 1 in a prophylactic way. Tachycardias on primary electrical disease are most frequent (46%). Hypertrophic cardiomyopathy accounts for 22%, DAVD for 14%, congenital cardiopathies for 12%. Seventeen patients received appropriate shocks and 14 patients had inappropriate shocks. There were two unexplained deaths. Five leads fractures and two device infections were noted. CONCLUSION: Implantable defibrillator is an effective treatment for children high-risk of sudden death. Occurrence of inappropriate shocks due to sinusal tachycardia, infections and leads fractures are frequent.     

植入型心律转复除颤器预防心脏性猝死

心脏性猝死(SCD)是威胁人类生命健康的可怕杀手,其主要原因多数为心室颤动(VF).植入型心律转复除颤器(ICD)具有有效终止恶性室性心律失常的功能,越来越多的临床试验证明ICD是预防SCD最为有效的方法.本文通过总结46例植入ICD患者追踪随访的结果,探讨ICD在预防心脏性猝死中的确切疗效.     

Implantable cardioverter defibrillators: risks accompany the life-saving benefits

Sudden cardiac arrest is the one of the most common causes of death in developed countries and accounts for between 180,000 and over 450,000 per year in the USA. Antiarrhythmic drug approaches to prevention of sudden cardiac death have been resoundingly ineffective. The implantable cardioverter defibrillator (ICD) constitutes one of the most important and well validated therapeutic advances in modern cardiovascular medicine. Consequently, ICD use has increased exponentially, although implementation has been quite variable geographically and with respect to other measures. In view of the expanded use of ICDs, the potential shortcomings and risks of ICD therapy have attracted attention. This commentary summarises the weaknesses, disadvantages and risks of the ICD in a balanced fashion in light of their proven life-saving benefits.     

Implantable cardioverter defibrillators for prevention of sudden cardiac death

Despite the multiple advances in the field of cardiovascular medicine, the incidence of sudden cardiac death (SCD) continues to rise. Of all SCDs, <25% occur in individuals deemed at high risk by current risk-stratification algorithms; hence, these risk-stratification algorithms are not satisfactory. Until better markers are identified to risk stratify patients, we will see an increasing use of implantable cardioverter defibrillators (ICDs). However, even with the increase in defibrillator use, the impact on overall incidence of SCD may only be modest, as many individuals experience SCD as the first manifestation of cardiovascular disease. Another important challenge is widespread availability of automated external defibrillators and effective utilization of public access defibrillation programs for timely and appropriate management of out-of-hospital victims with cardiac arrest. This review discusses the current understanding on SCD, risk stratification, and management aimed at reducing SCD, particularly with the use of ICDs.     

Implantable cardioverter defibrillators in Israel: utilization and implantation trends.

BACKGROUND: Since its introduction, the implantable cardioverter defibrillator (ICD) has evolved to its present status as the dominant therapeutic modality for patients with life-threatening arrhythmias. Several randomized studies have shown the benefit of ICD implantation as the first choice of treatment for primary as well as secondary indications for ventricular arrhythmias. Therefore, it is expected that the use of ICDs will increase further. The main objectives of this study were to analyze the Israeli experience with ICD implantation from 1993 to 1999, to examine the diffusion of ICD therapy in Israel and the evolution of implantation patterns and indications. METHODS: We conducted a retrospective review and analysis of an ICD registry for the period of January 1993-December 1999. Data collected included demographic, administrative, clinical and survival data. RESULTS: A total of 732 new implantations were identified and reviewed. The mean length of follow up of all patients was 30.7+/-21.1 months. 86% of patients were males and the mean age at implantation was 62.6+/-12.4 years. 79% of patients had CAD and the mean EF of all patients was 29.2+/-11.2%. 135 patients (18.4%) died during follow-up. One, two and three-year survival rates were calculated and were 92.7%, 87.8% and 82.0% respectively. A steady increase in implantation rate and in implanting centers was observed over the years. CONCLUSIONS: ICD therapy is relatively expensive; therefore a national registry which is continuously monitored may be the most expedient method to follow clinical and economic aspects of the utilization of this therapeutic modality.