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Circulation：植入式心律转复除颤器对Brugada患者治疗有效

2013-10-30 佚名 丁香园

心律转复除颤器Brugada
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Brugada患者年植入ICD比例 研究要点： 1.Brugada 综合症是一种离子通道基因异常所致的原发性心电疾病，患者属心源性猝死的高危人群。 2.植入式心律转复除颤器用于治疗Brugada患者是否有效目前仍存在争议。 3.研究结果发现，植入式心律转复除颤器对有症状及无症状Brugada患者均有效。优化植入式心律转复除颤器程控以及定期随访可显著减少除颤仪的不合理放电。 目前，植入


Brugada患者年植入ICD比例

研究要点：

1.Brugada 综合症是一种离子通道基因异常所致的原发性心电疾病，患者属心源性猝死的高危人群。

2.植入式心律转复除颤器用于治疗Brugada患者是否有效目前仍存在争议。

3.研究结果发现，植入式心律转复除颤器对有症状及无症状Brugada患者均有效。优化植入式心律转复除颤器程控以及定期随访可显著减少除颤仪的不合理放电。

目前，植入式心律转复除颤器用于治疗Brugada患者，尤其是无症状的Brugada患者，是否有效仍存在争议。既往针对此问题的研究结果多来源于少量样本的短期随访。基于此，法国Frédéric Sacher博士等人进行了一项研究，研究结果在线发表于2013年10月15日的Circulation杂志上。本项研究指出，植入式心律转复除颤器对Brugada患者治疗有效。

该研究为一项大规模、多中心临床注册研究，受试者包括378名1型Brugada患者，均植入植入式心律转复除颤器。其中31名患者既往有心跳骤停，181名患者既往发生晕厥，166名患者无明显症状。随访时间为77±42月。

研究结果表明，既往心跳骤停、晕厥和无症状患者10年随访的合理治疗率分别为48%，19%，12%.受试患者10年随访时，除颤器不合理放电比例为37%，除颤器电极失效比例为29%.导致不合理放电的原因主要包括：电极失效、室上性心动过速、T波过度感知以及窦性心动过速。除此以外，远程监控、提高室颤程控心率以及延长检测时间可减少不合理放电。

本研究建立在既往少量样本短期随访的研究基础上，研究结果发现，植入式心律转复除颤器对有症状及无症状Brugada患者均有效。优化植入式心律转复除颤器程控以及定期随访可显著减少除颤仪的不合理放电。此外，研究还指出，电极失效仍是影响植入式心律转复除颤器治疗效果的主要因素。

研究背景：

Brugada综合症是一种离子通道异常所致的家族性原发心电疾病。患者心脏结构多正常，心电图具有特征性 "三联征"：右束支阻滞、右胸导联（V1－V3） ST呈下斜形或马鞍形抬高、T波倒置，临床常因室颤或多形性室速引起反复晕厥、甚至猝死。本病于1992年由西班牙学者Brugada P和Brugada J两兄弟首先提出，1996年日本Miyazaki等将此病症命名为Brugada综合症。

Brugada综合症的治疗目的在于防止室颤发生，减少这部分患者猝死率。临床研究表明，目前尚缺乏理想药物实现有效治疗。目前唯一有效的办法只有安置植入型心脏除颤仪（ICD）。ICD能及时消除出现的室速或/和室颤，防止猝死发生。

国际第2届Brugada综合征专家共识会议推荐：对有I型Brugada ECG表现的症状性患者，如果曾有过心脏猝死发作史，无需再做电生理检查，应接受ICD治疗。患者如果出现相关症状如晕厥、抽搐或夜间濒死性呼吸，在排除非心脏原因后，可接受ICD治疗。无症状患者有I型 Brugada ECG表现时，如有心脏猝死家族史怀疑是由Brugada综合征导致的，应进行电生理检查。如果I型 Brugada 心电图表现是自发的，当猝死家族史是阴性时电生理检查可进行明确诊断。如果可诱发出室性，患者应该接受ICD治疗。

原文出处：

Sacher F, Probst V, Maury P, Babuty D, Mansourati J, Komatsu Y, Marquie C, Rosa A, Diallo A, Cassagneau R, Loizeau C, Martins R, Field ME, Derval N, Miyazaki S, Denis A, Nogami A, Ritter P, Gourraud JB, Ploux S, Rollin A, Zemmoura A, Lamaison D, Bordachar P, Pierre B, Jaïs P, Pasquié JL, Hocini M, Legal F, Defaye P, Boveda S, Iesaka Y, Mabo P, Haïssaguerre M.Outcome after implantation of a cardioverter-defibrillator in patients with brugada syndrome: a multicenter study-part 2.Circulation. 2013 Oct 15;128(16):1739-47. doi: 10.1161/CIRCULATIONAHA.113.001941.

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    2014-01-31 仁心济世

    #Brugad#

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    2014-08-10 zhangyxzsh

    #心律转复除颤器#

    0

  3. [GetPortalCommentsPageByObjectIdResponse(id=2081222, encodeId=2fea208122244, content=<a href='/topic/show?id=e1ab3e481d' target=_blank style='color:#2F92EE;'>#Brugad#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3748, encryptionId=e1ab3e481d, topicName=Brugad)], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyheQLjPSX3OUs5GmkyBlcCOwTPIeq3why9NGibxxUqYo6hcx8qZLHZFgNPnBK1yzWeOFpyg2OnWOt0/0, createdBy=fa4716, createdName=仁心济世, createdTime=Fri Jan 31 23:33:00 CST 2014, time=2014-01-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1952997, encodeId=4ae0195299ec3, content=<a href='/topic/show?id=9dd1510018f' target=_blank style='color:#2F92EE;'>#心律转复除颤器#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=51001, encryptionId=9dd1510018f, topicName=心律转复除颤器)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d8e0333, createdName=zhangyxzsh, createdTime=Sun Aug 10 08:33:00 CST 2014, time=2014-08-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1264485, encodeId=35a8126448512, content=<a href='/topic/show?id=150f19229c' target=_blank style='color:#2F92EE;'>#ADA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1922, encryptionId=150f19229c, topicName=ADA)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ad9f79, createdName=般若傻瓜, createdTime=Fri Nov 01 05:33:00 CST 2013, time=2013-11-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1405443, encodeId=52261405443ce, content=<a href='/topic/show?id=e2236265933' target=_blank style='color:#2F92EE;'>#植入式心律转复除颤器#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=62659, encryptionId=e2236265933, topicName=植入式心律转复除颤器)], attachment=null, authenticateStatus=null, createdAvatar=https://thirdwx.qlogo.cn/mmopen/vi_32/DYAIOgq83epZhGjURmwS4HgkUOJ0ENAAAL2ib1TCnskicRwY0z9phQQ7pWumsnjJswpPO87q8cyQ5h4B5iaXCAm5g/132, createdBy=37722549355, createdName=doctorzheng, createdTime=Fri Nov 01 05:33:00 CST 2013, time=2013-11-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1439112, encodeId=e67d143911257, content=<a href='/topic/show?id=8e3a98396f2' target=_blank style='color:#2F92EE;'>#除颤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=98396, encryptionId=8e3a98396f2, topicName=除颤)], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyheQLjPSX3OUs5GmkyBlcCOwTPIeq3why9NGibxxUqYo6hcx8qZLHZFgNPnBK1yzWeOFpyg2OnWOt0/0, createdBy=fa4716, createdName=zhouqu_8, createdTime=Fri Nov 01 05:33:00 CST 2013, time=2013-11-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1520232, encodeId=7157152023248, content=<a href='/topic/show?id=7a736264553' target=_blank style='color:#2F92EE;'>#植入#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=62645, encryptionId=7a736264553, topicName=植入)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=832411313664, createdName=jiyangfei, createdTime=Fri Nov 01 05:33:00 CST 2013, time=2013-11-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1590735, encodeId=bb8d1590e356a, content=<a href='/topic/show?id=86e23e49d6' target=_blank style='color:#2F92EE;'>#Brugada#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3749, encryptionId=86e23e49d6, topicName=Brugada)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=939917859602, createdName=nymo, createdTime=Fri Nov 01 05:33:00 CST 2013, time=2013-11-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1748714, encodeId=80aa1e487147c, content=<a href='/topic/show?id=4087626564c' target=_blank style='color:#2F92EE;'>#植入式#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=62656, encryptionId=4087626564c, topicName=植入式)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=cdca36191722, createdName=villahu, createdTime=Sat Nov 30 00:33:00 CST 2013, time=2013-11-30, status=1, ipAttribution=)]
    2013-11-01 般若傻瓜

    #ADA#

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=2081222, encodeId=2fea208122244, content=<a href='/topic/show?id=e1ab3e481d' target=_blank style='color:#2F92EE;'>#Brugad#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3748, encryptionId=e1ab3e481d, topicName=Brugad)], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyheQLjPSX3OUs5GmkyBlcCOwTPIeq3why9NGibxxUqYo6hcx8qZLHZFgNPnBK1yzWeOFpyg2OnWOt0/0, createdBy=fa4716, createdName=仁心济世, createdTime=Fri Jan 31 23:33:00 CST 2014, time=2014-01-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1952997, encodeId=4ae0195299ec3, content=<a href='/topic/show?id=9dd1510018f' target=_blank style='color:#2F92EE;'>#心律转复除颤器#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=51001, encryptionId=9dd1510018f, topicName=心律转复除颤器)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d8e0333, createdName=zhangyxzsh, createdTime=Sun Aug 10 08:33:00 CST 2014, time=2014-08-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1264485, encodeId=35a8126448512, content=<a href='/topic/show?id=150f19229c' target=_blank style='color:#2F92EE;'>#ADA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1922, encryptionId=150f19229c, topicName=ADA)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ad9f79, createdName=般若傻瓜, createdTime=Fri Nov 01 05:33:00 CST 2013, time=2013-11-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1405443, encodeId=52261405443ce, content=<a href='/topic/show?id=e2236265933' target=_blank style='color:#2F92EE;'>#植入式心律转复除颤器#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=62659, encryptionId=e2236265933, topicName=植入式心律转复除颤器)], attachment=null, authenticateStatus=null, createdAvatar=https://thirdwx.qlogo.cn/mmopen/vi_32/DYAIOgq83epZhGjURmwS4HgkUOJ0ENAAAL2ib1TCnskicRwY0z9phQQ7pWumsnjJswpPO87q8cyQ5h4B5iaXCAm5g/132, createdBy=37722549355, createdName=doctorzheng, createdTime=Fri Nov 01 05:33:00 CST 2013, time=2013-11-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1439112, encodeId=e67d143911257, content=<a href='/topic/show?id=8e3a98396f2' target=_blank style='color:#2F92EE;'>#除颤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=98396, encryptionId=8e3a98396f2, topicName=除颤)], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyheQLjPSX3OUs5GmkyBlcCOwTPIeq3why9NGibxxUqYo6hcx8qZLHZFgNPnBK1yzWeOFpyg2OnWOt0/0, createdBy=fa4716, createdName=zhouqu_8, createdTime=Fri Nov 01 05:33:00 CST 2013, time=2013-11-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1520232, encodeId=7157152023248, content=<a href='/topic/show?id=7a736264553' target=_blank style='color:#2F92EE;'>#植入#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=62645, encryptionId=7a736264553, topicName=植入)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=832411313664, createdName=jiyangfei, createdTime=Fri Nov 01 05:33:00 CST 2013, time=2013-11-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1590735, encodeId=bb8d1590e356a, content=<a href='/topic/show?id=86e23e49d6' target=_blank style='color:#2F92EE;'>#Brugada#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3749, encryptionId=86e23e49d6, topicName=Brugada)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=939917859602, createdName=nymo, createdTime=Fri Nov 01 05:33:00 CST 2013, time=2013-11-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1748714, encodeId=80aa1e487147c, content=<a href='/topic/show?id=4087626564c' target=_blank style='color:#2F92EE;'>#植入式#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=62656, encryptionId=4087626564c, topicName=植入式)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=cdca36191722, createdName=villahu, createdTime=Sat Nov 30 00:33:00 CST 2013, time=2013-11-30, status=1, ipAttribution=)]
    2013-11-01 doctorzheng

    #植入式心律转复除颤器#

    0

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    2013-11-01 zhouqu_8

    #除颤#

    0

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    2013-11-01 jiyangfei

    #植入#

    0

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    2013-11-01 nymo

    #Brugada#

    0

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    2013-11-30 villahu

    #植入式#

    0

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