|本期目录/Table of Contents|

用于减少不恰当治疗和死亡率的植入式除颤器的
编程和设置最新进展
(PDF)

《纳米技术与精密工程》[ISSN:1672-6030/CN:12-1351/O3]

期数:
2015年5期
页码:
366-375
栏目:
神经工程学中的精密测量、计算与控制技术
出版日期:
2015-09-15

文章信息/Info

Title:
Recent Progress in ICD Programming and Configurations for
Reducing Inappropriate Therapy and Mortality
作者:
?朱欣1 Noro Mahito2
?(1.日本会津大学生物医学信息技术实验室,会津若松9658580;2.日本东邦大学医疗中心大桥病院心内科,东京1538515)
Author(s):
?Zhu Xin1 Noro Mahito2
?(1.Biomedical Information Technology Laboratory, The University of Aizu, AizuWakamatsu 9658580, Japan;

2.Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, Tokyo 1538515, Japan)

关键词:
植入式除颤器(ICD)ICD编程室颤室性心动过速抗心动过速起搏心肌损伤
Keywords:
implantable cardioverter-defibrillator(ICD) ICD programming ventricular fibrillation ventricular tachycardia anti-tachycardia pacing myocardial injury
分类号:
R541.7+1;TH772
DOI:
10.13494/j.npe.20150030
文献标识码:
A
摘要:
?植入式除颤器(implantable cardioverter-defibrillator, ICD)植入是心脏性猝死的一次和二次预防最重要的治疗方法.然而非恰当和非必要的除颤和抗心动过速起搏会引起心肌

损伤继而导致预后的恶化和全死因死亡率的提高. ICD系统还会引起感染和各类并发症以致需要拔出整个系统.最新的ICD编程能够有效地减少不恰当和非必要的治疗,全皮下ICD和单线圈电

极导线有可能大大降低感染和并发症的发生率.本综述首先介绍了导致不恰当和非必要的治疗的原因,然后分析了ICD编程在区域编程、检测持续时间、上室性心动过速的检测和克服T波过感

知上的临床试验进展.另外就抗心动过速起搏、全皮下ICD、单/双线圈电极导线的选择进行了解释和讨论.通过使用经过临床试验论证的ICD编程能将不恰当治疗的个体发生率减少到病例的

3%.同时使用病例个性化的ICD编程和设置有望降低非恰当和非必要治疗以及各类并发症,能够减少因为ICD治疗导致的心肌损伤和全死因死亡率.

Abstract:
?Implantable cardioverter-defibrillators (ICDs) are the most important and effective tool for the primary and secondary prevention of sudden cardiac death

(SCD). However, inappropriate and unnecessary ICD therapy (shocks or anti-arrhythmia pacing (ATP)) causes myocardial injuries and therefore may worsen prognostics

and increase all causes of mortality. ICD systems also cause infections and complications, and should be removed completely. Recently, optimum ICD programming has

been proposed to reduce inappropriate and unnecessary therapies. Progress such as subcutaneous ICD (S-ICD) and the populariy of single-coil lead may also reduce

the infections and complications of ICD implantation. In this review, the causes of inappropriate and uncessary ICD therapies were introduced at first. Then we

described recent clinical trials on ICD programming related to zones programming, detection duration, supraventricular tachycardia (SVT) discrimination algorithms,

and T wave oversensing. Trends of ATP, SICD, the choice of single- or dual-coil leads were also explained and discussed. In conclusion, the safety and efficacy

of ICD programming have been proved based on randomized and non-randomized clinical trials, and inappropriate and unnecessary therapy has been reduced to less than

3% cases using optimum ICD programming and configurations. Future patientspecific ICD programming and configuration based on clinical evidence from clincal trials

may further minimize ICD inappropriate and unnecessary therapies and complications, and therefore minimize myocaridial injuries and all causes of mortaliy caused by

ICD therapy.

参考文献/References

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备注/Memo

备注/Memo:
收稿日期: 2015-06-05.
基金项目: 日本学术振兴会科学研究费资助项目(25330339).
作者简介: 朱欣(1977—), 男, 博士, 上级副教授.
通讯作者: 朱欣, zhuxin@u-aizu.ac.jp.
更新日期/Last Update: 2015-11-27