CAJ | 학술논문

目的对植入型心律转复除颤器(ICD)应用于缺血性或非缺血性心肌病慢性心力衰竭患者心脏性猝死(SCD)一级预防价值进行长期随访观察.方法 2002年3月至2011年10月入选56例缺血性或非缺血性心肌病患者,心功能Ⅱ～Ⅲ级(NYHA分级),左心室射血分数(LVEF)0.16 ～0.35(0.29±0.05),接受规范化抗心力衰竭药物治疗,植入ICD并进行ICD参数初步设置.术后1、3、6个月,以后每6个月随访1次.结果所有患者非开胸经锁骨下静脉植入ICD均成功.全部病例随访了1～115(44.05±35.16)个月.其中11例患者发生心室颤动26次(19.6％),ICD均电除颤成功；17例患者发生室性心动过速39次(30.4％),ICD治疗成功率94.8％.8例患者发生误放电,6例患者发生电风暴.16例患者ICD电池耗竭,10例患者更换了ICD.8例患者死亡.结论缺血性或非缺血性心肌病慢性心力衰竭患者是心脏性猝死的高危人群,应用ICD可降低这类患者的猝死风险.
목적 대식입형심률전복제전기(ICD)응용우결혈성혹비결혈성심기병만성심력쇠갈환자심장성졸사(SCD)일급예방개치진행장기수방관찰.방법 2002년3월지2011년10월입선56례결혈성혹비결혈성심기병환자,심공능Ⅱ～Ⅲ급(NYHA분급),좌심실사혈분수(LVEF)0.16 ～0.35(0.29±0.05),접수규범화항심력쇠갈약물치료,식입ICD병진행ICD삼수초보설치.술후1、3、6개월,이후매6개월수방1차.결과 소유환자비개흉경쇄골하정맥식입ICD균성공.전부병례수방료1～115(44.05±35.16)개월.기중11례환자발생심실전동26차(19.6％),ICD균전제전성공；17례환자발생실성심동과속39차(30.4％),ICD치료성공솔94.8％.8례환자발생오방전,6례환자발생전풍폭.16례환자ICD전지모갈,10례환자경환료ICD.8례환자사망.결론 결혈성혹비결혈성심기병만성심력쇠갈환자시심장성졸사적고위인군,응용ICD가강저저류환자적졸사풍험.
Objective To evaluate the clinical benefits of implantable cardioverter defibrillator for the primary prevention of sudden cardiac death(SCD) in the patients with chronic heart failure due to either ischemic or nonischemic dilated cardiomyopathy.Methods We retrospectively enrolled 56 patients who were diagnosed with chronic heart failure caused by either ischemic or nonischemic dilated cardiomyopathy from March 2002 to October 2011.Patients were graded NYHA class Ⅱ and Ⅲ,with left ventricular ejection fraction (LVEF) at 0.16 ～ 0.35 (0.29 ± 0.05).All patients voluntarily took standard medicine treatment of chronic heart failure and underwent implantable cardioverter defibrillator (ICD) implantation and initial parameters were set up.All enrolled patients were followed up at 1,3,and 6 months,and every 6 months thereafter.Results ICD was implanted via the subclavian vein successfully in all patients.During the follow-up period of 1 ～ 115 (44.05±35.16) months,11 patients had 26 episodes of ventricular fibrillation(19.6％),which were defibrillated successfully; 17 patients had 39 episodes of ventricular tachycardia(VT,30.4％),which were terminated successfully at 94.8％.Besides,failure of ICD termination of VT occurred in 1 patient for twice and the arrhythmia was self-terminated later.Inadequate shocks were found in 8 patients.Electrical storm occurred in 6 cases.ICD battery was exhausted in 16 patients and 10 patients accepted replacement of ICD.Eight patients died.Conclusions The patients with chronic heart failure due to either ischemic or nonischemic dilated cardiomyopathy are at high risk of SCD.ICD implantation can reduce the risk of SCD for the primary prevention.