Meisel E, Butter C, Philippon F, Higgins S, Strickberger S A, Smith J, Hahn S, Michel U, Schubert B, Pfeiffer D
Heart and Circulation Center, Dresden, Germany.
Am J Cardiol. 2000 Nov 2;86(9A):76K-85K. doi: 10.1016/s0002-9149(00)01295-9.
The recent success of biventricular pacing with transvenously implantable left ventricular leads suggests that left ventricular leads may be useful for other modes of therapy. Animal studies showed small leads inserted into a left ventricular vein dramatically reduced defibrillation strength requirements. This article describes a human investigation of the feasibility of biventricular defibrillation. Fifty-one patients undergoing implantable cardioverter defibrillator (ICD) implantation were enrolled. After insertion of a standard ICD lead, a prototype over-the-wire left ventricular defibrillation lead was inserted through the coronary sinus and into a vein on the left ventricle. Lead insertion was guided by retrograde venography. The left ventricular lead's location was randomized to the anterior or posterior vein. Randomized, paired defibrillation threshold (DFT) testing was performed to compare a standard ICD shock configuration (Control: right ventricle- --> superior vena cava+ + CAN+) to 1 of 3 biventricular shock configurations. In the anterior vein, the left ventricular lead was tested with either a single biphasic shock from right ventricle + left ventricle- --> superior vena cava+ + CAN+ or a dual biphasic shock. In the posterior vein, the left ventricular lead was tested with a dual biphasic shock. Dual shocks consisted of a 40% tilt biphasic shock from right ventricle- --> superior vena cava+ + CAN+ followed by another 40% tilt biphasic shock from left ventricle- --> superior vena cava+ + CAN+, delivered from a single 225 microF capacitance. Left ventricular lead positioning was successful in 41 of 46 patients (89%). Mean left ventricular lead insertion time was 17 +/- 17 minutes and 13 +/- 15 minutes for anterior and posterior locations, respectively. Mean DFTs were not statistically lower for the left ventricular shock configurations, but retrospective analysis showed a well-defined region of the posterolateral left ventricle where consistent DFT reduction was achieved with dual shocks (14.0 +/- 2.7 J vs 7.8 +/- 0.9 J; n = 5; p = 0.04). There were no adverse events requiring intervention due to the use of the left ventricular lead. Biventricular defibrillation is feasible and safe under the conditions used in this study. Additional studies are needed to verify whether dual shocks with posterolateral left ventricular lead positions consistently reduce DFTs.
经静脉植入左心室导线进行双心室起搏最近取得的成功表明，左心室导线可能对其他治疗模式有用。动物研究显示，插入左心室静脉的小导线可显著降低除颤能量需求。本文描述了一项关于双心室除颤可行性的人体研究。纳入了51例接受植入式心脏复律除颤器（ICD）植入的患者。在插入标准ICD导线后，将一个原型的经钢丝左心室除颤导线经冠状窦插入左心室的一条静脉中。导线插入由逆行静脉造影引导。左心室导线的位置随机分配至前静脉或后静脉。进行随机、配对的除颤阈值（DFT）测试，以比较标准ICD电击配置（对照：右心室→上腔静脉++心房程控刺激电极+）与3种双心室电击配置中的1种。在前静脉中，用来自右心室+左心室→上腔静脉++心房程控刺激电极+的单次双相电击或双次双相电击测试左心室导线。在后静脉中，用双次双相电击测试左心室导线。双次电击包括来自右心室→上腔静脉++心房程控刺激电极+的40%倾斜双相电击，随后是来自左心室→上腔静脉++心房程控刺激电极+的另一次40%倾斜双相电击，由单个225微法电容释放。46例患者中有41例（89%）左心室导线定位成功。前位和后位的平均左心室导线插入时间分别为17±17分钟和13±15分钟。左心室电击配置的平均DFT在统计学上没有更低，但回顾性分析显示，左心室后外侧有一个明确的区域，双次电击在此区域可使DFT持续降低（14.0±2.7焦耳对7.8±0.9焦耳；n = 5；p = 0.04）。未发生因使用左心室导线而需要干预的不良事件。在本研究使用的条件下，双心室除颤是可行且安全的。需要进一步研究以验证左心室导线置于后外侧位置的双次电击是否能持续降低DFT。
