Effects Of ICD/CRT-D Implantation On Cardiac Function And Optimal Management

Objective: To retrospectively analyze the effects of implanted cardioverter-defibrillation defibrillator(ICD)and cardiac resynchronization therapy defibrillator(CRT-D)implantation on cardiac function and optimal management.Providing guidance for the application of ICD/CRT-D in the clinic.Methods: Twenty-nine patients were selected to receive ICD / CRT-D implantation and discharge at the First Affiliated Jijishan Hospital of Wannan Medical College from January2016 to August 2019.A total of 47 shocks events were recorded.After ICD / CRT-D implantation,all patients continued to use anti-arrhythmic drugs and anti-heart failure drugs,followed regularly at 1,3,and 6 months after discharge.The follow-up contents included cardiac function assessment(using NYHA classification),echocardiography Maps(LVEDD,LVEF,etc.),BNP,CRT / CRT-D intracardiac ECG and ECG examination.Immediate hospitalization for patients with conscious palpitations,palpitations,syncope,or near syncope and ICD / CRT-D shocks events,improve cardiac function assessment(using NYHA classification),echocardiography(LVEDD,LVEF,etc.),BNP,CRT / CRT-D intra-cavity electrocardiogram and ECG examination to evaluate cardiac function changes before and after shocks,as well as the number of defibrillator defibrillation times and shocks types(appropriate shocks and inappropriate shocks)in patients during shocks events To optimize the management of the cause of shocks.Results: Among our patients with ICD / CRT-D implanted in our department from 2016 to2019,postoperative shocks occurred in 29 patients,a total of 47 shocks events were recorded,and 2 of them experienced repeated ventricular electrical storms.After shocks,cardiac function(LVEDD,LVEF,BNP,cardiac function classification,QRSd,etc.)showedsignificant deterioration compared with the pre-shocks follow-up(P <0.05);the greater the number of intra-cavity defibrillations,the more significant the cardiac function deterioration,There was statistical significance(P <0.05);both appropriate shocks and inappropriate shocks would worsen cardiac function,but the difference between the two in affecting cardiac function was not statistically significant(P> 0.05).inappropriate shocks occurred in11 patients with postoperative discharge,6 patients entered the diagnostic interval of ventricular fibrillation due to atrial fibrillation(AF)with fast ventricular rate,and 3 patients identified supraventricular ventricular tachycardia(SVT)as ventricular tachycardia,An inappropriate discharge was generated,one person's electrode lead was faulty,and one person's T wave was over-perceived.By adjusting anti-arrhythmia and anti-heart failure drugs to reduce ventricular rate,optimizing ICD / CRT-D program control settings to reduce inappropriate shocks and adjusting electrodes,etc.,to achieve effective management of ICD/ CRT-D postoperative shocks.Conclusion: The shocks after ICD / CRT-D implantation has an impact on cardiac function and worsens cardiac function;the more frequent intra-cavity defibrillation,the more significant cardiac function worsens;both appropriate and inappropriate shocks can worsen cardiac function but There is no significant difference between the two;individualized treatments such as adjusting postoperative medication,program-controlled parameters,and adjusting electrodes can effectively manage ICD / CRT-D postoperative shocks.