中文摘要：

目的探讨美托洛尔剂量调整在治疗置入型心律转复除颤器（ICD）术后电风暴（ES）中的作用。方法回顾性分析119例ICD患者的临床随访资料，Es定义为24h内出现3次或3次以上的室性快速性心律失常（VTA）导致ICD治疗或ICD监测到持续30s以上的VTA，但未发放治疗。结果在（27．5±21．2）个月的随访期内，有39例（32．8％）患者发生Es，平均年龄（52．0±13．1）岁。Es患者中共有9例死亡，存活的30例患者中，25例在Es急性期予去除诱因（5例）、优化ICD工作参数与调整抗心律失常药物（16例）和导管射频消融（4例）后，Es得以控制，另5例Es自行终止。慢性期除2例Brugada综合征患者单用奎尼丁治疗以外，余23例患者将美托洛尔口服剂量由（26．8±13．9）mg／d逐步上调至（88．9±53．5）mg／d后，ES均未再次发作，且VTA发生次数较剂量调整前显著减少[（1．9±1．7）次／月与（0．8±0．6）次／月，P=0．004]。另16．7％（5／30）的患者美托洛尔日剂量需上调至平均（255．3±41．7）mg时，ES才得以控制。结论在治疗ICD术后ES时，美托洛尔应个体化足量使用，约1／6的患者日剂量需要超过200mg。

英文摘要：

Objective To explore the effectiveness of the metoprolol dosage adjustment on reducing the incidence of electrical-storm （ ES ） in patients with Implantable Cardioverter Defibrillators （ ICDs ）. Methods Data from patients with ICD implantation between Jan, 2003 and Jun, 2006 in our hospital were retrospectively analyzed. ES was defined as either ≥ 3 times of ventricular tachyarrhythmias （VTAs） resulting in ICD therapy or VTAs lasting more than 30 s detected by ICD without any therapy within 24 hours. Results During a follow-up period of （ 27.5 ± 21.2 ） months, ES was recorded in 39 cases [ 34 males, average age （52. 0± 13.1 ） years ] out of 119 patients （32. 8% ） and 9 patients died after ES. During the period of storm attack, ES was successfully controlled in 25/30 patients by various interventions, including predisposing factors corrected in 5 cases, ICD reprogramming and antiarrhythmic drugs therapy optimized in 16 cases （one received intravenous injection of metoprolol）, and VTAs eliminated by catheter ablation in 4 cases. ES was spontaneously resolved in the remaining 5 cases. In the chronic phase, 2 patients with Brugada syndrome were treated with Quinidine mono-therapy while the dosage of metoprolol was adjusted in the remaining 23 patients and the dosage of metoprolol was increased gradually from （26. 8 ± 13.9）mg/d to （88. 9 ±53.5） mg/d without any adverse effects （9 patients received also oral amiodarone 200 mg/d）. Post dosage adjustment, the total VTA episodes [ （ 1.9 ± 1.7 ） times/month vs. （ 0. 8± 0. 6） times/month, P = 0. 004 ], incidence of antitachycardia pacing therapies [ （ 4. 2± 3.8 ） runs/month vs. （2. 3 ± 2.0） runs/month, P = 0. 003 ], as well as electrical cardioversion or defibrillation [ （ 1.1 ± 0. 9 ） times/month vs. （0.4±0. 2）times/month,P =0. 001 ] were significantly decreased. ES was not controlled until a extremely high dosage [ 225 -300 （255.3± 41.7 ）mg/d ] of metoprolol was reached in the remaining 5 pat