Dijkman B, Wellens H J
Department of Cardiology, Academic Hospital Maastricht, The Netherlands.
J Cardiovasc Electrophysiol. 2000 Dec;11(12):1309-19. doi: 10.1046/j.1540-8167.2000.01309.x.
Performance of dual chamber implantable cardioverter defibrillator (ICD) systems has been judged based on functioning of the ventricular tachycardia:supraventricular tachycardia (VT:SVT) discrimination criteria and DDD pacing. The purpose of this study was to evaluate the use of dual chamber diagnostics to improve the electrical and antiarrhythmic therapy of ventricular arrhythmias.
Information about atrial and ventricular rhythm in relation to ventricular arrhythmia occurrence and therapy was evaluated in 724 spontaneous arrhythmia episodes detected and treated by three types of dual chamber ICDs in 41 patients with structural heart disease. Device programming was based on clinically documented and induced ventricular arrhythmias. In ambulatory patients, sinus tachycardia preceded ventricular arrhythmias more often than in the hospital during exercise testing. The incidence of these VTs could be reduced by increasing the dose of a beta-blocking agent in only two patients. In five patients in whom sinus tachycardia developed after onset of hemodynamic stable VT, propranolol was more effective than Class III antiarrhythmics combined with another beta-blocking agent with regard to the incidence of VT and pace termination. In all but three cases, atrial arrhythmias were present for a longer time before the onset of ventricular arrhythmias. During atrial arrhythmias, fast ventricular rates before the onset of ventricular rate were observed more often than RR irregularities and short-long RR sequences. Dual chamber diagnostics allowed proper interpretation of detection and therapy outcome in patients with different types of ventricular arrhythmia.
The advantages of the dual chamber ICD system go further than avoiding the shortcomings of the single chamber system. Information from the atrial chamber allows better device programming and individualization of drug therapy for ventricular arrhythmia.
双腔植入式心脏复律除颤器（ICD）系统的性能一直是根据室性心动过速：室上性心动过速（VT:SVT）鉴别标准和DDD起搏功能来判断的。本研究的目的是评估双腔诊断在改善室性心律失常的电治疗和抗心律失常治疗中的应用。
在41例患有结构性心脏病的患者中，对三种类型的双腔ICD检测和治疗的724次自发性心律失常发作中，与室性心律失常发生和治疗相关的心房和心室节律信息进行了评估。设备编程基于临床记录和诱发的室性心律失常。在门诊患者中，窦性心动过速比运动试验期间在医院中更常先于室性心律失常出现。仅在两名患者中，通过增加β受体阻滞剂的剂量可降低这些室性心动过速的发生率。在5例血流动力学稳定的室性心动过速发作后出现窦性心动过速的患者中，就室性心动过速的发生率和起搏终止而言，普萘洛尔比Ⅲ类抗心律失常药联合另一种β受体阻滞剂更有效。除3例病例外，在所有病例中，心房心律失常在室性心律失常发作前存在的时间更长。在心房心律失常期间，室性心律发作前的快速心室率比RR不规则和短-长RR序列更常被观察到。双腔诊断有助于正确解释不同类型室性心律失常患者的检测和治疗结果。
双腔ICD系统的优势不止于避免单腔系统的缺点。来自心房腔的信息有助于更好地进行设备编程以及针对室性心律失常进行个体化药物治疗。
