Sgarbossa E B, Black I W, Maloney J D
Cleveland Clinic Foundation, Ohio.
Curr Opin Cardiol. 1993 Jan;8(1):27-38. doi: 10.1097/00001573-199301000-00005.
Technology for pacemakers and automatic implantable defibrillators continues to evolve. Emphasis is placed not only on preventing cardiac death, but also on improving symptoms and quality of life. The basic antibradycardia function of pacemakers is complemented by highly sophisticated rate-responsive capabilities. The search for the perfect physiologic sensor has not ended; potential limitations of the systems currently available are considered in this review. Reports on outcome with pacing in different populations are also discussed. There have been two important advances in automatic implantable defibrillators. One is the introduction of the third generation defibrillator in clinical investigation. A tiered therapy (including antitachycardia pacing, cardioversion, and defibrillation) can now be programmed in the same device, with the protection of back-up antibradycardia pacing. The other remarkable innovation is the expanding use of nonthoracotomy techniques for implantable cardioverter-defibrillator placement. This approach permits the avoidance of a subcutaneous patch electrode in some cases, the system being entirely transvenous. Finally, recent insights on external cardioversion for atrial arrhythmias are briefly reviewed.
起搏器和植入式自动除颤器技术不断发展。不仅强调预防心脏性死亡，还注重改善症状和生活质量。起搏器的基本抗心动过缓功能辅以高度复杂的频率应答功能。寻找完美生理传感器的工作尚未结束；本综述考虑了现有系统的潜在局限性。还讨论了不同人群起搏治疗结果的报告。植入式自动除颤器有两项重要进展。一是第三代除颤器进入临床研究。现在同一设备可程控分层治疗（包括抗心动过速起搏、心脏复律和除颤），并具备备用抗心动过缓起搏保护功能。另一显著创新是越来越多地采用非开胸技术植入心脏复律除颤器。这种方法在某些情况下可避免使用皮下贴片电极，整个系统完全经静脉。最后，简要回顾了近期关于房性心律失常体外心脏复律的见解。
