Refractory Chest Pain Induced by Implantable Cardioverter-Defibrillator in a Patient with Advanced Cancer: What Is the Best Timing for Deactivation of an ICD?
Refractory Chest Pain Induced by Implantable Cardioverter-Defibrillator in a Patient with Advanced Cancer: What Is the Best Timing for Deactivation of an ICD?
复制标题
晚期癌症患者植入式心脏复律除颤器引起的顽固性胸痛：停用 ICD 的最佳时机是什么？
DOI：
10.1089/jpm.2019.0126
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发表时间：
2019
影响因子：
2.8
通讯作者：
Inoue Akira
中科院分区：
文献类型：
--
作者：
Hiratsuka Yusuke;Tagami Keita;Inoue Akira
尊敬的编辑：由于植入式心律转复除颤器（ICD）技术的最新进展，接受植入式心律转复除颤器（ICD）的癌症患者数量正在增加。针对心力衰竭患者的新指南1建议将 ICD 停用的讨论作为预先护理计划 (ACP) 的一部分。然而，尚无指南涉及癌症患者的 ICD 停用问题。在之前的报告中，2、3、31%的ICD患者在死亡前24小时内因缺氧和电解质不平衡引发的心动过速而经历过休克，而频繁休克的患者疼痛更严重。我们在此报告一例晚期癌症患者在临终阶段因 ICD 电击引起的顽固性胸痛。与多位专家合作，通过适当的 ACP 停用 ICD，胸痛消失。一名 70 岁男性患有特发性扩张型心肌病和慢性心力衰竭，于 2017 年 7 月被诊断出原发灶不明的癌症。由于他的预期寿命超过几个月，因此于 2017 年 11 月因症状性室性心动过速植入 ICD。当他在终止抗癌治疗后于 2018 年 7 月转诊到我们门诊时，我们讨论了多位专家（肿瘤学家、心脏病专家和姑息治疗专家）共同决定 ICD 停用的时间。当时，我们决定在死亡前立即停用 ICD，因为他的预后似乎由癌症进展和致命性心律失常共同决定。事实上，他的 ICD 记录显示在讨论之前的过去几个月里有几次 ICD 冲击。病人和他的妻子同意了我们的建议。 2018 年 8 月入住我们的姑息治疗病房时，他主诉经常出现剧烈胸痛，阿片类药物等镇痛药对这种疼痛无效。国际疾病分类
Dear Editor: Because of recent progress in implantable cardioverterdefibrillator (ICD) technology, the number of patients with cancer who undergo placement of ICDs is increasing. Novel guidelines1 for patients with heart failure recommend discussion of ICD deactivation as a part of advance care planning (ACP). However, no guidelines have addressed ICD deactivation for patients with cancer. In previous reports, 2, 3 31% of patients with ICDs experienced shocks in the past 24 hours before death due to tachycardia triggered by hypoxia and electrolyte imbalances and patients who experienced frequent shocks suffered from more severe pain. We herein report a case involving a patient with advanced cancer who developed refractory chest pain induced by ICD shocks in his end-oflife stage. The chest pain disappeared by ICD deactivation through appropriate ACP in cooperation with multiple experts.A 70-year-old man with idiopathic dilated cardiomyopathy and chronic heart failure was diagnosed with carcinoma of unknown primary in July 2017. Because his life expectancy was longer than several months, an ICD was implanted for symptomatic ventricular tachycardia in November 2017. When he was referred to our outpatient clinic in July 2018 after termination of anticancer treatments, we discussed the timing of ICD deactivation among multiple experts (oncologists, cardiologists, and palliative care specialists). At that time, we decided that the ICD should be deactivated immediately before death because his prognosis seemed to be determined by both cancer progression and lethal arrhythmia. In fact, his ICD records showed several ICD shocks during the past few months before the discussion. The patient and his wife agreed with our suggestion. On admission to our palliative care unit in August 2018, he complained frequent severe chest pain that was refractory to analgesics such as opioids. The ICD