摘要目的 回顾性观察植入型心律转复除颤器(ICD)或心脏再同步治疗除颤器(CRT-D)植入术后不恰当放电患者的临床特征,分析ICD/CRT-D不恰当放电发生原因,探讨不恰当放电的处理方法,以期进一步减少不恰当放电风险.方法 选择2011年1月至2018年1月至南京医科大学第一附属医院住院因心脏性猝死一级或二级预防植入ICD/CRT-D患者,随访术后出现不恰当放电的患者,分析不恰当放电的发生率、临床特点、不恰当放电原因以及处理方法.结果 研究共纳入植入ICD/CRT-D患者289例,随访274例,失访1 5例,不恰当放电治疗的共21例,发生率7.66％.不恰当放电治疗的患者年龄(56.38±13.23)岁,年龄范围为24～78岁,其中男20例,女1例.2例患者因房性心动过速不恰当放电(9.52％),9例因心房颤动(房颤)伴快速心室率误诊断放电治疗(42.86％),6例因窦性心动过速不恰当放电(28.57％),2例因除颤导线磨损导致阻抗及感知异常致不恰当放电(9.52％),1例因室性心动过速区识别频率低而出现不恰当放电治疗(4.76％),1例因T波感知异常,双重计数不恰当放电(4.76％).结论 ICD/CRT-D不恰当放电的原因主要为室上性心律失常,包括房颤、房性心动过速以及窦性心动过速,可以通过提高诊断频率,调整心室间期稳定性参数以及打开心动过速突发性等方式避免不恰当放电.

abstractsObjective To observe the clinical characteristics of the patients who received inappropriate shocks after implantable cardioverter defibrillator (ICD) or cardiac resynchronization therapy defibrillator (CRT-D) implanted.To discuss the causes of inappropriate shocks and explore the solution to this problems.Methods Patients who were enrolled received ICD/CRT-D therapy for primary or secondary prevention of sudden cardiac death (SCD) between January 2011 and January 2018.During follow-up,the occurrence of inappropriate ICD shocks was noted,and we analyzed the incidence,clinical characteristics,causes,and treatment methods of inappropriate ICD shocks.Results A total of 289 patients were enrolled in the research.Fifteen patients were loss of follow-up.Inappropriate shocks occurred in 21 patients with an average age of (56.38± 13.23) years old,which ranged from 24 to 78 years old,while males accounts for 20 cases of them.Two cases (952％) was caused by atrial tachycardia.Nine cases (42.86％) were atrial fibrillation which were misdiagnosed as ventricular tachycardia (VT).Six cases (2857％) of the patients with sinus tachycardia were shocked.Two cases (9.52％) were resulted from the frayed wire and improper sensing.One case (4.76％) was shocked because of low recognition frequency in VT region.One patient (4.76％) had abnormal Twave sense and was shocked with double count ofT wave.Conclusion The main cause of inappropriate shocks with ICD/CRT-D was supraventricular arrhythmia,including atrial fibrillation,atrial tachycardia and sinus tachycardia.Inappropriate shocks can be avoided by improving rate parameters of diagnostic,adjusting interventricular stability parameters and turning on sudden tachycardia.