ICD在治疗恶性室性心律失常中的作用
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摘要
目的观察植入式心脏复律除颤器(ICD)对恶性室性心律失常的治疗效果,同时与单纯药物治疗效果相对比,对ICD治疗恶性室性心律失常的疗效及安全性做一评估。方法符合2002年ACC/AHA/NASPE关于ICD临床应用I类及IIa类指证的104例患者,分为ICD加药物治疗组和单纯药物治疗组,两组患者除晕厥、心肺复苏及确诊的VF, ICD组多于单纯药物治疗组外,其余基础病、EF、心功能、心律失常等临床特征相似,并接受相同的基础治疗。比较两组随访后1、2、3年的生存率、心律失常性死亡及心脏事件发生率。结果104例患者观察期内,ICD组26例患者中第1年、第2年、第3年无因心律失常事件死亡病例,死亡率为0%。而单纯药物组78例患者中因心律失常事件死亡病例分别为6、14、17例,死亡率分别为7.69.%, 17.94%, 21.79%,3年ICD组较单纯药物组死亡率下降了21.79%, P<0.05,差异有统计学意义。26例ICD植入者资料分析有18例(73.1%)出现恶性室性心律失常,其中469次为非持续性室速(自行终止),持续性室速发作265次,经ATP分层治疗1阵转复成功245次(92.5%),2阵转复成功13次(4.89%),ATP治疗转复未成功经低能量电转复7次(2.64%)。室颤发作41次,其中14次在释放治疗前室颤自己终止,经电除颤治疗1次成功36次(87.80% ), 2次成功5次(12.2%)。两组之间心律失常事件发病率基本相等,但ICD组全部转复VT/V成功,两组间因心律失常事件死亡率相比,差异有统计学意义。结论ICD对于合并有恶性室性心律失常的心脏病人预防猝死的总体效果优于单纯药物治疗,ICD能有效终止恶性室性心律失常,降低心脏性猝死的死亡率,提高患者生存率,而且此趋势随着随访期的延长更加明显。在ICD分层治疗中,ATP功能能有效终止室速,避免和减少ICD放电,减少患者由除颤造成的痛苦,同时减轻患者经济负担。
Obective To observe the effects of implantable cardioverter defibrillator ICD and antiarrhythmic on malignant ventricular arrhythmia , discuss the prevention of sudden cardiac death and safety.Methods In the 104 selected patients who have the indication class I and IIa, 26 patients received ICD (ICD group), and 78 patients receive drug treatment. Patients in the two groups had the similar clinical symptoms such as basic disease, EF, cardiac function, and cardiac arrhythmia, except that patients with syncope, CPR, and VF in ICD group were more than in drug treatment. Patients in the two groups received same basic therapy. 1years, 2 years, and 3years after patients were selected, the total death rate and the incidence rate of cardiac events of patients in the two groups were compared. Results During the observation time, in the selected 104 patients there was no death in the 26 patients in ICD group in 1years, 2 years, and 3years. The total death rate was 0. While in the 78 patients drug treatment group, 6, 14, and 17 patients died respectively in 1years, 2 years, and 3years, and the death rate was 7.69.%, 17.94%,, and 21.79% respectively. When observation time reached 3years, the death rate of patients in ICD group was lower than drug treatment group by 21.79%, the difference was considered statistically significant (P <0.05). 18(73.1%) patients in 26 ICD group, the storage data revealed that 469 episodes of nonsustained VT which spontaneously terminated. 265 episodes were sustained VT,245(92.5%) episodes treated by 1 ATP treatment succe -ssfully.13(4.89%) episodes treated by 2 ATP treatment successfull y, and 7(2.64%) episodes ATP treatment failed resort to low energy cardiov -ersion.41 episode were VF which 14 spontaneously terminated before discharged.36 VF episodes (87.80%) were terminated by 1 energy shocks.5 (12.2%) VF episodes were terminated by 2 energy shocks successfully.and compared with drug group they had similar ventricular arrhythmia incidence but VT/VF were terminated by energy cardioversion succes -sfullyin ICD group, to compare with drug group the incidence of ventricular arrhythmia ,The difference was considered statistically significant .Conclusions ICD group is better than drug group on the preventive effect of sudden cardiac death to the patients with heart disease complicating malignant ventri- cular arrhythmia,ICD can effectively stop malignant ventricular arrhythmia,decrease the incidence rate of sudden death and death rate, and improve the survival rate of patients. especially in the long term follow up patients. The layer function of ICD, VT can bet erminated effectivelly by antitachycardi apacing,Avoided and diminished ICD discharge,Relieved painess by defibrillator .and relived patiets economics load.
Obective To observe the effects of implantable cardioverter defibrillator ICD and antiarrhythmic on malignant ventricular arrhythmia , discuss the prevention of sudden cardiac death and safety.Methods In the 104 selected patients who have the indication class I and IIa, 26 patients received ICD (ICD group), and 78 patients receive drug treatment. Patients in the two groups had the similar clinical symptoms such as basic disease, EF, cardiac function, and cardiac arrhythmia, except that patients with syncope, CPR, and VF in ICD group were more than in drug treatment. Patients in the two groups received same basic therapy. 1years, 2 years, and 3years after patients were selected, the total death rate and the incidence rate of cardiac events of patients in the two groups were compared. Results During the observation time, in the selected 104 patients there was no death in the 26 patients in ICD group in 1years, 2 years, and 3years. The total death rate was 0. While in the 78 patients drug treatment group, 6, 14, and 17 patients died respectively in 1years, 2 years, and 3years, and the death rate was 7.69.%, 17.94%,, and 21.79% respectively. When observation time reached 3years, the death rate of patients in ICD group was lower than drug treatment group by 21.79%, the difference was considered statistically significant (P <0.05). 18(73.1%) patients in 26 ICD group, the storage data revealed that 469 episodes of nonsustained VT which spontaneously terminated. 265 episodes were sustained VT,245(92.5%) episodes treated by 1 ATP treatment succe -ssfully.13(4.89%) episodes treated by 2 ATP treatment successfull y, and 7(2.64%) episodes ATP treatment failed resort to low energy cardiov -ersion.41 episode were VF which 14 spontaneously terminated before discharged.36 VF episodes (87.80%) were terminated by 1 energy shocks.5 (12.2%) VF episodes were terminated by 2 energy shocks successfully.and compared with drug group they had similar ventricular arrhythmia incidence but VT/VF were terminated by energy cardioversion succes -sfullyin ICD group, to compare with drug group the incidence of ventricular arrhythmia ,The difference was considered statistically significant .Conclusions ICD group is better than drug group on the preventive effect of sudden cardiac death to the patients with heart disease complicating malignant ventri- cular arrhythmia,ICD can effectively stop malignant ventricular arrhythmia,decrease the incidence rate of sudden death and death rate, and improve the survival rate of patients. especially in the long term follow up patients. The layer function of ICD, VT can bet erminated effectivelly by antitachycardi apacing,Avoided and diminished ICD discharge,Relieved painess by defibrillator .and relived patiets economics load.
引文
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[2] A Comparison of antiarrhythmic-drug therapy with implantable defibrilltators in patients resuscitated from nearfatal ventricular arrhythmias.The antiarrhythmics versus implanted defibrillato AVID Investigators. N Engl Med, 1997,337: 1576-1583.
[3] Connolly SJ, Gent M, Roberts RS, et al. Canadian Implantable Defibrillator Study(CIDS): a randomized trial of the implantable cardioverter defibrillator against amiodarone. Circulation, 2000,101:1297-1302.
[4] Kuck KH, Cappato R, Siebels J, et al. Randomized comparison of antiarrhy thmic drug therapy with implantable defibrillators in patients resuscitated from cardiac arrest: the Cardiac Arrest Study Hamburg (CASH). Circulation, 2000,102:748-754.
[5] Moss AJ, hall wj, Cannom DS, el al. Improved survival with an implanted defibrillator in patients with coronary disease at high rist for ventricular arrhythmia.Multicenter Automatic Defibrillator Implantation Trial Investigators. N Engl J Med 1996,335: 1933～1940.
[6] Moss AJ, Cannom DS, Daubert JP, et al. for the MADIT 11 investigators, Multicenter automatic defibrillator implantation trial II (MADIT II):design andclinical protocol. Ann Noninvasive Electrocardiol, 1999, 4: 83～91.
[7] Kowey P Levine JH, Herre JM, et al. Randomized, double-blind comparison of intravenous arniodarone and bretylium in the treatment of patients with recurrent hemodynamically destabilizing ventricular tachycardia or fibrillation. circulation, 1995, 92: 3225.
[8] Scheinman MM,Levine JH, Cannom DS, et al. Dose-ranging study of intravenous amiodarone in patients with life-threatening tachyarrhythmias. Circulation, 1995, 92: 3264.
[9] Singh SN. For the survival trial of antiarrhythmic therapy in congestive heart failure. Amiodarone in patients with congestive heart and asymptomatic ventricular arrhythmia. N Engl J Med, 1995, 92: 3264～3272.
[10] Mirowski M, Mower MM, Staewen WS, et al. Ventricular defibrillation through a single intravascular catheter electrode system (abstract). Clin Res, 1971,19:328.
[11] Mirowski M, Mower MM, Gott VL, et al. Feasibility and effectiveness of low energy
[12] catheter defibrillation in man. Circulation, 1973,47:79～85.
[13] Huikuri HV, Castellanos A, Myerburg RJ. Sudden death due to cardiac arrhythmias. N Engl J Med, 2001, 345: 1473～1482.
[14] State-specific mortality from sudden cardiac death-United States, 1999. MMWR Morb Mortal Wkly Rep, 2002, 51:123～126.
[15] Myerburg RJ, Fenster J, Velez M, et al. Impact of community-wide police car deployment of automated external defibrillators on survival from out-of- hospital cardiac arrest. Circulation, 2002, 106: 1058～1064.
[16] Pell JP, Sirel JM, Marsden AK, et al. Potential impact of public access defibrillators on survival after out of hospital cardiopulmonary arrest: retrospective cohort study. BMJ, 2002, 325: 515～517.
[17] Bunch TJ, White RD, Gersh BJ, et al. Long-term outcomes of out-of-hospital cardiac arrest after successful early defibrillation. N Engl J Med, 2003, 348: 2626-2633.
[18] Buxton AE, Lee KL, FisherJD, et al. A randomized study of the Prevention of sudden death in patients with coronary artery disease. N Engl J Med, 1999, 34:1882-1890.
[19] Julian DG,Camm AJ ,Frangin G,et al. Randomozed trial of amiodarone on mortality in patients with left - ventricular dysfunction after recent myocardialinfarction. EMIAT. European Myocar dial Infarct Amiodarone Trial Inveatigators [J].Lancet,1997,349(2) :667-674
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