置入式心脏复律除颤器治疗Brugada综合征

目的 对Brugada综合征患者置入治疗性或预防性置入式心脏复律除颤器(ICD)并评价1个月临床随访结果。方法 21例Brugada综合征(症状性9例、无症状性12例)于全麻下常规方法置入ICD。每例有Brugada综合征心电图(ECG)典型改变或钠通道阻滞剂揭示的ECG改变。排除了结构性心脏病并作心脏电生理检查。无症状患者中自发或诱发室性心律失常8例，仅有阳性家族史4例。结果 置入单腔ICD(VVI)16台，双腔ICD(DDD或DDDR)5台(患者伴窦房结功能异常和，或房室传导障碍)。术中电极除颤器电生理参数符合常规，术后无并发症。1个月后再入院ICD电生理参数检查未改变，除颤器内记录无室速和(或)室颤触发的拮抗心动过速起搏或电复律、电除颤发生。结论 Brugada综合征患者可安全成功置入ICD，初期(1个月)随访ICD工作良好。

Implantation of cardioverter defibrillator in patients with Brugada syndrome and the initial outcomes in one-month follow-up

Objective To assess the value of implanting remedial or prophylactic cardioverter defibrillator in patients with Brugada syndrome for protecting from malignant ventricular arrhythmias and to estimate the initial outcomes in one-month follow-up. Methods Implantable cardioverter defibrillators (ICDs) were implanted in 21 consecutive patients (9 symptomatic and 12 asymptomatic) with Brugada syndrome using standard procedure under general anesthesia. Patients presented the typical ECG changes of Brugada syndrome with or without sodium channel blockers but without structural heart disease in all the cases. Electrophysiological examinations were performed in all patients. Eight asymptomatic patients had spontaneous or induced malignant ventricular arrhythmias and 4 asymptomatic patients had single positive family history. Results Sixteen single chamber ICDs (VVI) and 5 double chamber ICDs (DDD or DDDR) were implanted. The DDD- or DDDR-ICDs were applied for patients with sinus node dysfunction and/or atrioventricular conduction disturbances. Battery/lead status measurements of ICDs were good and met with standards of implantation during the procedure. No complications occurred after ICD implantation and also no changes of various electrophysiological parameters during re-hospitalization in one-month follow-up. There were no events' record of anti-tachycardia pacing or cardiovertion or defibrillation for ventricular arrhythmias in the memory of treatment by ICDs. Conclusions ICDs were implanted successfully with safety in patients with Brugada syndrome showing good function for the initial outcomes in one-month follow-up.