The treatment of malignant ventricular arrhythmias with combined endocardial resection and implantation of the automatic defibrillator: preliminary report.
The treatment of malignant ventricular arrhythmias with combined endocardial resection and implantation of the automatic defibrillator: preliminary report.
复制标题
心内膜切除联合自动除颤器植入治疗恶性室性心律失常：初步报告。
DOI：
10.1016/s0003-4975(10)60711-4
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发表时间：
1984
期刊：
影响因子：
--
通讯作者：
Reid,PR
中科院分区：
文献类型：
--
作者：
WatkinsJr,L;Platia,EV;Mower,MM;Griffith,LS;Mirowski,M;Reid,PR
对14例顽固性快速室性心律失常患者行腔内电切术和自动除颤器植入术。有11名男性和3名女性，平均年龄为53岁（范围：41 - 58岁）。所有患者均患有冠状动脉疾病;平均射血分数为26%，平均心脏骤停次数为2.6次。程序电刺激诱发持续性室性心动过速13例，非持续性室性心动过速1例。13例持续性室性心动过速患者经手术心内膜标测，9例室间隔早期激动灶，4例非室间隔部位。切除后，持续性室性心动过速不能再诱发。有1例手术死亡。术后1个月程序电刺激诱发室性心动过速5例，存活8例未诱发室性心动过速，最长随访32个月，平均17个月。有2例晚期死亡。1例死于心肌梗死，1例死于常规胆囊切除术后肺水肿。另一例患者出现晚期室性心动过速，但被植入的除颤器自动终止。这些结果表明，内膜切除术结合自动除颤器植入术可能为恶性室性快速性心律失常患者提供最大的保护。
Fourteen patients with refractory ventricular tachyarrhythmias were treated with combined endocardial resection and implantation of the automatic defibrillator. There were 11 men and 3 women with a mean age of 53 years (range, 41 to 58 years). All patients had coronary artery disease; the mean ejection fraction was 26%, and the mean number of cardiac arrests was 2.6. Programmed electrical stimulation induced sustained ventricular tachycardia in 13 patients and nonsustained ventricular tachycardia in 1.Operative endocardial mapping in the 13 patients with sustained ventricular tachycardia demonstrated a septal focus of early activation in 9 patients and a nonseptal site in 4. Following resection, sustained ventricular tachycardia could not be reinduced. There was 1 operative death. Programmed electrical stimulation performed one month after operation induced ventricular tachycardia in 5 patients, but tachycardia could not be induced in the other 8 survivors.The longest follow-up was 32 months; the average was 17 months. There were 2 late deaths. One patient died of myocardial infarction and 1 of pulmonary edema following a routine cholecystectomy. In another patient, late ventricular tachycardia developed but was automatically terminated by the implanted defibrillator. These results suggest that endocardial resection combined with implantation of the automatic defibrillator may offer the greatest protection yet available to patients with malignant ventricular tachyarrhythmias.