CAJ | 학술논문

目的：探讨植入埋藏式心脏除颤器（ICD）的患者出现频繁放电的原因及处理方法。方法随访80例因心力衰竭或恶性室性心律失常植入ICD的患者，男62例，女18例，其中单腔ICD 35例，双腔ICD 23例，三腔ICD （CRTD）22例，随访1~6年，了解ICD的放电原因，并根据具体情况进行治疗。结果80例患者中有23例患者遭受电击，其中10例为频繁电击（24 h内电击≥3次或1年内电击≥5次），均为心脏猝死二级预防患者。频繁电击的原因包括：室速反复发作，除颤阈值升高电击无效，对频繁发作的短阵室速或室上性心律失常的误识别。处理方法：调整室速与室上速鉴别流程，增加室速判定心搏数目及充分利用ICD的起搏功能；联合使用抗心律失常药物，尤其是美托洛尔和（或）胺碘酮。经ICD参数优化和抗心律失常药物治疗后电击明显减少。结论抗心律失常药物的合理应用和有效ICD程控可在保障患者安全的同时明显减少ICD电击。
목적：탐토식입매장식심장제전기（ICD）적환자출현빈번방전적원인급처리방법。방법수방80례인심력쇠갈혹악성실성심률실상식입ICD적환자，남62례，녀18례，기중단강ICD 35례，쌍강ICD 23례，삼강ICD （CRTD）22례，수방1~6년，료해ICD적방전원인，병근거구체정황진행치료。결과80례환자중유23례환자조수전격，기중10례위빈번전격（24 h내전격≥3차혹1년내전격≥5차），균위심장졸사이급예방환자。빈번전격적원인포괄：실속반복발작，제전역치승고전격무효，대빈번발작적단진실속혹실상성심률실상적오식별。처리방법：조정실속여실상속감별류정，증가실속판정심박수목급충분이용ICD적기박공능；연합사용항심률실상약물，우기시미탁락이화（혹）알전동。경ICD삼수우화화항심률실상약물치료후전격명현감소。결론항심률실상약물적합리응용화유효ICD정공가재보장환자안전적동시명현감소ICD전격。
Objective To investigate the cause and countermeasures of frequent shocks in patients with implantable cardioverter defibrillators (ICD). Methods Eighty ICD patients with heart failure and malignant ventricular arrhythmias were followed up, including sixty-two male and eighteen female patients. There were 35 patients with single-chamber ICD, 23 with dual-chamber ICD and 22 with three-chamber ICD. Patients in this study were followed up for 1-6 years to analyze the reasons for ICD discharge. According to the specific circumstances, patients were treated. Results Twenty-three pa-tients in 80 patients suffered from shock treatment. Ten patients (12.5%) experienced frequent shocks. The causes of fre-quent shock included repeated episodes of ventricular tachycardia, invalid shock due to increased defibrillation threshold (DF) and false identification of the frequent episodes of paroxysmal ventricular tachycardia or arrhythmias. The management included the identification process adjustment of ventricular tachycardia and supraventricular tachycardia, increased num-bers of beats of ventricular tachycardia judgment and increase the basic pacing rate. The anti-arrhythmic drugs should be combinedly used, especially metoprolol and amiodarone. The ICD shock was significantly reduced after parameter optimiza-tion and anti-arrhythmic therapy. Conclusion The ICD shocks were effectively reduced with rational use of anti-arrhyth-mic drugs and valid ICD programming.