Sticherling C, Schaumann A, Klingenheben T, Hohnloser S H
Department of Cardiology, J.W. Goethe University, Frankfurt, Germany.
Europace. 1999 Apr;1(2):96-102. doi: 10.1053/eupc.1998.0023.
The need for physiological pacing and for improving the ability to discriminate atrial from ventricular tachyarrhythmias has prompted the development of dual chamber implantable cardioverter/defibrillators (ICDs).
Fifty-two patients were implanted with a newly developed dual-chamber ICD providing rate-responsive physiological pacing (Ventak AV II DR). The device possesses two new arrhythmia detection algorithms ('atrial fibrillation rate threshold' and 'ventricular to atrial rate relationship') in addition to commonly used features such as 'onset' and 'stability'. During implantation, the atrial and ventricular lead impedances and pacing thresholds were determined together with the defibrillation threshold. Prior to discharge, attempts were made to induce both atrial and ventricular tachyarrhythmias in order to test those new detection criteria. All patients were followed for at least 3 months.
The device was successfully implanted in all 52 patients. Placement of the atrial lead was successful in 50/52 patients (96%; P-wave 3.2 +/- 1.4 mV; impedance 576 +/- 123 omega; atrial pacing threshold 1.2 +/- 0.9 V). Prior to discharge, 32 episodes of atrial fibrillation (AF) alone, 38 episodes of AF with ventricular fibrillation and 10 episodes of AF with monomorphic ventricular tachycardia were induced in 33/50 patients (66%) and all were appropriately classified by the detection algorithm. During the 3 months follow-up, 12 patients (23%) had appropriate and successful therapies for ventricular arrhythmias, while four patients (8%) experienced inappropriate ICD therapies. Although all these episodes were detected correctly as supraventricular arrhythmias by the device, therapy was delivered because of incorrect or incomplete programming. In all cases reprogramming of the device resolved the problem.
Implantation of dual chamber ICDs is feasible and appears to improve discrimination of supraventricular from ventricular tachyarrhythmias. In addition, patients with tachyarrhythmias and concomitant bradyarrhythmias may benefit from simultaneous physiological pacing. However, implantation and follow-up of such patients should be performed at experienced centres since both surgical handling and programming of these devices is more difficult and complex than conventional ICDs.
对生理性起搏的需求以及提高鉴别房性与室性快速心律失常的能力促使了双腔植入式心脏复律除颤器（ICD）的发展。
52例患者植入了新研发的提供频率应答生理性起搏功能的双腔ICD（Ventak AV II DR）。该装置除了具备常用功能如“发作”和“稳定性”外，还拥有两种新的心律失常检测算法（“房颤频率阈值”和“室房频率关系”）。植入过程中，测定了心房和心室导线阻抗、起搏阈值以及除颤阈值。出院前，尝试诱发房性和室性快速心律失常以测试这些新的检测标准。所有患者至少随访3个月。
52例患者均成功植入该装置。50/52例患者（96%）心房导线植入成功（P波3.2±1.4 mV；阻抗576±123Ω；心房起搏阈值1.2±0.9 V）。出院前，33/50例患者（66%）诱发了32次单纯房颤发作、38次房颤合并室颤发作以及10次房颤合并单形性室性心动过速发作，且所有发作均被检测算法正确分类。在3个月的随访期间，12例患者（23%）因室性心律失常接受了恰当且成功的治疗，而4例患者（8%）经历了不恰当的ICD治疗。尽管所有这些发作均被该装置正确检测为室上性心律失常，但由于编程错误或不完整而进行了治疗。所有病例通过对装置重新编程解决了问题。
双腔ICD植入是可行的，且似乎能改善室上性与室性快速心律失常的鉴别。此外，患有快速心律失常并伴有缓慢性心律失常的患者可能从同步生理性起搏中获益。然而，此类患者的植入和随访应在经验丰富的中心进行，因为这些装置的手术操作和编程比传统ICD更困难、更复杂。
