CAJ | 학술논문

目的观察Brugada综合征患者植入式心脏复律除颤器(ICD)长期随访疗效,探讨如何减少ICD不恰当治疗.方法对1998年至2012年间本院心脏科植入ICD治疗的14例Brugada综合征患者进行长期随访.ICD初始参数按传统方法设置室性心动过速(室速)区(心室率150～188次/min,周期长度400～320 ms)和心室颤动(室颤)区(心室率≥188次/min,周期长度≤320 ms).每6个月随访1次,程控分析各种心律失常发作类型和治疗效果,如有不恰当治疗则调整ICD参数.结果 14例Brugada综合征患者,均为男性,年龄(44.3±8.3)岁,平均随访(43.0±28.3)个月.共记录到297次室颤和(或)室速事件,其中室颤事件198次(67％),有90％(178/198)为真实室颤(周期长度130 ～250 ms),其中147次被ICD电击1次治疗成功,21次通过2次及以上治疗成功,另外10次事件自行终止.而99次室速事件中仅9次(9％)为真实室速(周期长度320 ～360 ms),其中8次被抗心动过速起搏转复为窦性心律,1次自行终止.其余90次(91％)事件均为室上性心动过速(周期长度340～390 ms).打开波形鉴别功能并根据心律失常发作特点调整室颤/室速诊断阈值后设置室颤区(心室率≥222次/min,周期长度≤270 ms)和(或)室速区(心室率167 ～ 222次/min,周期长度270～ 360 ms),可减少约90％的误放电.结论 ICD可以有效预防高危的Brugada综合征患者心原性猝死和晕厥.室上性心动过速是导致ICD不恰当放电的最常见原因,根据心律失常发作特点进行个体化ICD参数设置,合理使用波形鉴别功能,可有效减少不恰当放电.
목적 관찰Brugada종합정환자식입식심장복률제전기(ICD)장기수방료효,탐토여하감소ICD불흡당치료.방법 대1998년지2012년간본원심장과식입ICD치료적14례Brugada종합정환자진행장기수방.ICD초시삼수안전통방법설치실성심동과속(실속)구(심실솔150～188차/min,주기장도400～320 ms)화심실전동(실전)구(심실솔≥188차/min,주기장도≤320 ms).매6개월수방1차,정공분석각충심률실상발작류형화치료효과,여유불흡당치료칙조정ICD삼수.결과 14례Brugada종합정환자,균위남성,년령(44.3±8.3)세,평균수방(43.0±28.3)개월.공기록도297차실전화(혹)실속사건,기중실전사건198차(67％),유90％(178/198)위진실실전(주기장도130 ～250 ms),기중147차피ICD전격1차치료성공,21차통과2차급이상치료성공,령외10차사건자행종지.이99차실속사건중부9차(9％)위진실실속(주기장도320 ～360 ms),기중8차피항심동과속기박전복위두성심률,1차자행종지.기여90차(91％)사건균위실상성심동과속(주기장도340～390 ms).타개파형감별공능병근거심률실상발작특점조정실전/실속진단역치후설치실전구(심실솔≥222차/min,주기장도≤270 ms)화(혹)실속구(심실솔167 ～ 222차/min,주기장도270～ 360 ms),가감소약90％적오방전.결론 ICD가이유효예방고위적Brugada종합정환자심원성졸사화훈궐.실상성심동과속시도치ICD불흡당방전적최상견원인,근거심률실상발작특점진행개체화ICD삼수설치,합리사용파형감별공능,가유효감소불흡당방전.
Objective To observe the long-term outcome of implantable cardioverter-defibrillator (ICD) implantation in Brugada syndrome patients and to explore how to reduce the frequency of ICD inappropriate schocks.Methods This study included 14 symptomatic patients (mean age (44.3 ± 8.3)years old;all males) with Brugada syndrome implanted with ICD in our hospital between 1998 and 2012,and these patients were followed up routinely every 6 months.The initial ICD parameters were set according to conventional experience.The ventricular tachycardia (VT) zone was programmed to ventricular rate 150-188 bpm/cycle length (CL) 400-320 ms and the ventricular fibrillation (VF) zone was programmed to ventricular rate≥ 188 bpm/CL≤320 ms.The total events were recorded by ICD.The ICD parameters revision was made by electrophysiological (EP) experts in case of inappropriate shocks.Results Patients were followed up for mean (43.0 ± 28.3) months.A total of 297 VF/VT events were recorded by ICD.Electrophysiological experts found that 90％ (178/198) episodes were true VF (CL 130-250 ms) among of 198 VF episodes and 147 VF episodes were terminated by one shock and 21 VF events were terminated by two or more shocks,and the rest 10 VF terminated spontaneously.Only 9％ (9/99) VT events were true VT (CL 320-360 ms) among of 99 VT episodes.Eight VT episodes were converted by antitachycardia pacing therapy (ATP) and the other one terminated spontaneously.The rest 90 VT episodes (91％) were supraventricular arrhythmias (SVT,CL 340-390 ms).About 90％ inappropriate shocks can be reduced by Wavelet discrimination function and optimal programming (VF zone ventricular rate ≥222 bpm/CL ≤ 270 ms and/or VT zone ventricular rate 167-222 bpm/CL 270-360 ms) according to the characteristics of arrhythmia of individual patient.Conclusion ICD can effectively prevent sudden cardiac death and syncope in high-risk patients with Brugada syndrome.The most common complication is inappropriate shock due to SVT.Optimal ICD programming with Wavelet discrimination function can effectively reduce the frequency of inappropriate shock rate.