可植入式心脏转复除颤器误治疗研究

发布时间：2018-04-13 12:45

本文选题：可植入式心脏转复除颤器 + 误治疗　；参考：《北京协和医学院》2015年博士论文

【摘要】：研究目的我们通过北京协和医院单中心、回顾性研究分析ICD误治疗的发生率、常见原因、预测指标及对临床预后的影响,并探索减少ICD误治疗的方法。研究方法2006年1月至2014年12月在北京协和医院心内科首次植入ICD,术后在我院规律随访的患者纳入本研究进行分析。通过问诊和查阅病历,收集患者临床资料,并调阅患者ICD随访资料与事件记录。由3位有经验的起搏电生理专业医生根据ICD治疗事件腔内心电图对ICD治疗事件进行鉴别诊断。如果治疗不是针对室性心动过速或心室颤动则该治疗定义为误治疗。研究结果123例患者符合研究入选标准,中位数随访时间36个月,共计28人(22.8%)发生误治疗。ICD共记录292次治疗事件,其中误治疗161次(55.1%)。误治疗事件中频率在"VT/FVT"识别区间的有118次,其中单纯ATP治疗90次(76.3%)；ATP治疗后发生放电的误治疗事件多数(96%)为在1-2阵ATP后即发生放电。房颤/房扑是引起误治疗的最常见原因(63.3%),房颤/房扑病史(OR:5.3,95% CI:1.7-16.4,p=0.004)、单腔ICD (OR:5.5,95% CI:1.8-16.3, p=0.002)、无高血压病史(OR: 3.7,95% CI:1.2-11.7, p=0.025)以及无糖尿病病史(OR:7.6,95% CI:1.9-30.9, p=0.005)是ICD误治疗的独立预测指标。单腔ICD误治疗发生率显著高于双腔ICD/CRT-D (p0.001)。ICD误治疗在一级预防、二级预防的患者中无显著性差异(p=0.433)。结论ICD误治疗发生率较高,房颤/房扑是引起误治疗最常见的原因。既往房颤/房扑病史、单腔ICD以及无高血压、无糖尿病合并症的患者可能是ICD误治疗的高危人群。多阵ATP设置有益于减少误放电的发生。
[Abstract]:Objective to retrospectively analyze the incidence, common causes, predictors and effects on clinical prognosis of ICD mistreatment through the single center of Peking Union Hospital, and to explore ways to reduce the mistreatment of ICD.Methods from January 2006 to December 2014 ICD was implanted in Department of Cardiology Beijing Union Hospital for the first time.The patient's clinical data were collected and the follow-up data and event records of ICD were collected by consulting and consulting the medical records.According to the intracavitary electrocardiogram (ECG) of ICD treatment, three experienced pacing electrophysiologists were used to differentiate and diagnose the ICD treatment events.If the treatment is not for ventricular tachycardia or ventricular fibrillation, the treatment is defined as mistreatment.Results 123 patients met the criteria of the study. The median follow-up time was 36 months. A total of 28 patients (22. 8%) had been mistreated. ICD recorded 292 treatment events, of which 161 were mistreated (55. 1%).The frequency of mistreatment events was 118times in the "VT/FVT" recognition interval. Among them, 90 times of ATP treatment occurred discharge after ATP treatment. Most of the mistreatment events occurred after 1 or 2 arrays of ATP.The incidence of single-chamber ICD mistreatment was significantly higher than that of double-lumen ICD/CRT-D p0.001n.ICD. there was no significant difference in primary prophylaxis.Conclusion the incidence of ICD mistreatment is high, atrial fibrillation / atrial flutter is the most common cause of mistreatment.Previous history of atrial fibrillation / atrial flutter, single chamber ICD and patients without hypertension and without diabetes mellitus may be high risk groups for ICD mistreatment.Multi-array ATP is helpful to reduce the occurrence of false discharge.
【学位授予单位】：北京协和医学院
【学位级别】：博士
【学位授予年份】：2015
【分类号】：R541.7

【相似文献】