CAJ | 학술논문

目的分析老年患者埋藏式心律转复除颤器(ICD)误放电发生原因并探讨相应的处理方法. 方法对植入ICD的患者进行随访,应用体外程控仪记录误放电发生时的事件情况并进行分析. 结果 95例患者共随访235例次/年,出现ICD误放电16例,误放电原因包括心室误感知7例(43.7％),室上速误认为室性心动过速4例(25.0％),其他误放电5例(31.3％),包括ICD电极磨损2例(12.5％),肌电干扰、肌肉电刺激仪、电极磨损合并肌电干扰各1例(各占6.3％).经程控及无创处理后可减少及避免再次误放电11例,其中1例经程控后出现感知低下,未能正确识别心室颤动,经体外除颤后转复；余5例经有创处理好转. 结论植入ICD患者可出现多种类型的误放电,可根据不同ICD进行相应参数调整,在保证ICD感知灵敏度的同时减少误放电.
목적 분석노년환자매장식심률전복제전기(ICD)오방전발생원인병탐토상응적처리방법. 방법 대식입ICD적환자진행수방,응용체외정공의기록오방전발생시적사건정황병진행분석. 결과 95례환자공수방235례차/년,출현ICD오방전16례,오방전원인포괄심실오감지7례(43.7％),실상속오인위실성심동과속4례(25.0％),기타오방전5례(31.3％),포괄ICD전겁마손2례(12.5％),기전간우、기육전자격의、전겁마손합병기전간우각1례(각점6.3％).경정공급무창처리후가감소급피면재차오방전11례,기중1례경정공후출현감지저하,미능정학식별심실전동,경체외제전후전복；여5례경유창처리호전. 결론 식입ICD환자가출현다충류형적오방전,가근거불동ICD진행상응삼수조정,재보증ICD감지령민도적동시감소오방전.
Objective To analyze the causes of inappropriate discharge of implantable cardioverter defibrillator (ICD) in elderly patients and to discuss the corresponding solutions.Methods Totally 95 elderly patients with ICD were collected.They were followed up and the inappropriate ICD discharges were recorded and analyzed.Results All patients were followed up for 235 times/year totally.There were 16 patients with inappropriate ICD discharges.The causes of inappropriate ICD discharges included ventricular oversensing in 7 patients (43.7％),supraventricular tachycardia misclassified into ventricular tachycardia in 4 patients (25.0％),electrode fracture in 2 patients (12.5％),and electromyogram (EMG) interference,electromagnetic interference and electrode fracture with EMG interference in 1 patients respectively (6.3％ each).11 inappropriate ICD discharges were reduced and avoided by reprogrammed and noninvasive treatment in 16 patients.1 patient with the underdetected ventricular fibrillation after reprogramming and the problem was solved by external defibrillation.The other 5 patients got better by the invasive treatment.Conclusions Different causes account for inappropriate discharges in patients with ICD.Reprogramming the corresponding parameters in different ICD can reduce or avoid inappropriate discharges without affecting the sensitivity of ICD.