埋藏式心脏转复除颤器参数优化减少不适当电击吴冬燕.docVIP

埋藏式心脏转复除颤器参数优化减少不适当电击 吴冬燕 卢凤民 付乃宽 许静 ［摘要］目的 分析埋藏式心脏转复除颤器（ICD）参数优化在减少ICD不适当电击中的作用。方法 62例植入ICD的患者，男45例，女17例，植入单腔ICD 29例，双腔ICD 13例，三腔ICD 20例，随访20.6±14.6个月。结果 6例出现不适当电击，占9.7%。其中双腔ICD 5例，三腔ICD 1例。出现不适当电击的患者的临床特征与其他患者并无区别。在分析患者发生不适当电击的原因后在抗心律失常药物的基础上调整优化ICD参数，包括：延长快室性心动过速（FVT）或VT2区的识别心搏数目；提高心室颤动区的判定心搏数目和低限频率；调整PR Logic分区比值；严格室上性心动过速与室性心动过速的鉴别流程。经治疗后6例均未再发生不适当电击。结论 根据患者出现不适当电击的临床情况和ICD的内在鉴别流程，个体化ICD参数优化是减少不适当电击的有效手段。 ［关键词］心血管病学；参数优化；埋藏式心脏转复除颤器；不适当电击 Optimal programming of implantable cardioverter defibrillator as a means to reduce inappropriate shocks. WU Dong-yan, LU Feng-min, FU Nai-kuan, XU Jing. Department of Cardiology, Tianjin Chest Hospital, Tianjin 300051, China Corresponing author: XU Jing, E-mail: drxj@ ［Abstract］Objective To demonstrate the specific role of the optimization of implantable cardioverter defibrillators (ICD) on the reduction of inappropriate ICD shocks. Methods From Jan 2006 to Jul 2011, 62 recipients of ICDs were surveyed and ICDs were optimally programmed. Results During the follow-up period of half a year to 5 years, 6 of 62 patients (9.7%) experienced inappropriate shocks. Of the 6 patients, five were implanted with dual-chamber ICDs and one with the resynchronization therapy system(CRTD). There were no significant differences in the clinical characteristics of patients who experienced inappropriate shocks versus those who did not. After giving anti-arrhythmia therapy and optimization programming, inappropriate shocks did not occur. The optimization strategy include increasing the number of intervals to detect (NID) in the FVT zone, increasing the NID and its detection rate in the VF zone in order to lengthen the detection window, the optimal programming of the relative size of the antegrade zone in PR Logic and the individual programming of the supraventricular tachycardia discrimination algorithm. Conclusion By using programming options that specifically address each patient′s special characteristics and needs, the majority of