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題名 | Implantable Cardioverter Defibrillator Therapy: Ten Years Experience in a Medical Center=植入型心臟去顫復律器--單一醫學中心之十年治療經驗 |
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作者 | 陳恬恩; 王俊傑; 張尚宏; 葉森洲; 吳德朗; | 書刊名 | 長庚醫學 |
卷期 | 31:1 2008.01-02[民97.01-02] |
頁次 | 頁81-90 |
分類號 | 416.262 |
關鍵詞 | 植入型心臟去顫復律器; 心臟猝死症; 心室頻脈; 心室顫動; 心臟衰竭; Implantable cardioverter defibrillator; Sudden cardiac death; Ventricular tachycardia; Ventricular fibrillation; Heart failure; |
語文 | 英文(English) |
中文摘要 | 背景:植入型心臟去顫復率器(implantable cardioverter defibrillator-ICD)是治療致命性心律不整或心因性猝死的主要選擇,然而在臺灣有關ICD治療的臨床特徵及治療預後的資料相當有限。本研究藉由分析單一醫學中心過去十年之ICD治療經驗找出影響預後的因子。 方法:自1996年至2006年一月,計有49顆ICD植入46位病患。平均追蹤32±21個月,蒐集並分析人口統計學資料,原始心臟病診斷,心律不整之表現,心臟超音波檢查,血流動力學檢查,電氣生理檢查的數據及回診追蹤的臨床表徵與ICD治療紀錄。分析結果並與臺灣ICD登錄研究(Taiwan ICD Multicenter Registry-TIMR)以及文獻上大型次級預防性ICD研究報告相比較。 結果:本研究之病患與TIMR相似,但較西方國家報告的病患年輕,且有較佳左心室輸出分率(LVEF)。結果發現LVEF<35%,紐約心臟學會功能分級III或IV,左心房直徑≥55mm,左心室舒張末期直徑≥75mm或收縮末期直徑≥60mm,有冠狀動脈心臟病,三條血管病變或是曾有前壁心肌梗塞,以及在追蹤過程中使用過amiodarone或利尿劑的病患,有較高的死亡率。並患有非缺血性心臟病或是擴張性心肌病變的結構性心臟病,有較高的心律不整復發率。 結論:左心室功能是ICD接受預後的主要影響因子,此類病患應當積極治療其心臟衰竭。 |
英文摘要 | Background: An implantable cardioverter defibrillator (ICD) is the therapy of choice for survivors of life-threatening ventricular tachyarrhythmias or sudden cardiac death. To date there is little data concerning the clinical features and outcome of ICD therapy among Taiwanese. This study identifies factors related to the outcome of ICD therapy over a ten-year period at this institution. Methods: Forty-nine ICDs were implanted in 46 patients between August 1996 and January 2006. The mean follow-up duration was 32 21 months. Patient data, primary cardiac diagnosis, presenting cardiac arrhythmia, echocardiographic parameters, hemodynamic indexes, electrophysiologic findings, and follow-up observations were analyzed. The findings were compared to those of the Taiwan ICD Multicenter Registry (TIMR) Study and major secondary prevention ICD trials in the literature. Results: The patients in this study were comparable to those of TIMR but were younger and had better left ventricular ejection fractions (LVEF) than those in Western countries. Furthermore, higher mortality on follow-up was observed in patients with any of the following: LVEF < 35%, New York Heart Association (NYHA) functional class III or IV, a left atrial dimension. 55 mm, a left ventricular end diastolic dimension. 75 mm, an end systolic dimension. 60 mm, triple vessel disease, a prior anterior myocardial infarction, and amiodarone or diuretic therapy. Patients with structural heart disease other than ischemic heart disease or dilated cardiomyopathy had higher event recurrence rates. Conclusion: Left ventricular function is a major determinant affecting the outcome in ICD recipients. Aggressive treatment for heart failure is warranted in these patients. |
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