Sperzel J, Pitschner H F, Schwarz T, König A, Zhu Q, Neuzner J
Kerckhoff-Klinik, Department of Cardiology and Electrophysiology, Benekestrasse 2-8, 61231, Bad Nauheim, Germany.
Europace. 2003 Jan;5(1):83-9. doi: 10.1053/eupc.2002.0279.
Intracardiac ventricular evoked-response (ER) signals detected by implanted cardioverter defibrillator (ICD) lead systems were investigated for automatic capture verification (AC).
ER signals were evaluated with an external pacing system equipped with a reduced coupling capacitance (CC=2.2 microF) in the pacing output circuit during ventricular step-down threshold testing at 0.4 ms pulse duration. Real-time pacing markers, surface ECG and intracardiac electrograms pre- and post-filtering were digitally recorded.
Twenty consecutive patients, age 61+/-12 years, with leads from two different manufacturers were tested - 10 were implanted with acute leads (AL) and 10 with chronic leads (CL). The analysis was based on the ER amplitude during capture and on the ER-to-afterpotential ratio (SAR), with SAR>2 as the criterion for successful capture detection. ER amplitudes (median and range) were 8.1 mV (2.1-19.5 mV) for AL and 8.3 mV (3.7-14.2 mV) for CL. SAR values (median and range) were 48.0 (2.5-682.6) for AL and 13.2 (6.3-35.9) for CL, indicating that AC could successfully be applied in all patients.
Reducing the pacing CC allows adequate ER detection for automatic capture verification on non-selected ICD lead systems. The effect of high-voltage shock treatment on ER signal detection requires further investigation.
研究植入式心脏复律除颤器（ICD）导联系统检测到的心室内诱发反应（ER）信号用于自动夺获验证（AC）的情况。
在脉宽为0.4 ms的心室递减阈值测试期间，使用起搏输出电路中耦合电容降低（CC = 2.2微法）的外部起搏系统评估ER信号。对实时起搏标记、体表心电图以及滤波前后的心腔内电图进行数字记录。
对20例连续患者（年龄61±12岁）进行了测试，这些患者的导联来自两个不同制造商，其中10例植入了急性导联（AL），10例植入了慢性导联（CL）。分析基于夺获期间的ER幅度以及ER与后电位比值（SAR），以SAR>2作为成功检测到夺获的标准。AL的ER幅度（中位数和范围）为8.1 mV（2.1 - 19.5 mV），CL的为8.3 mV（3.7 - 14.2 mV）。AL的SAR值（中位数和范围）为48.0（2.5 - 682.6），CL的为13.2（6.3 - 35.9），这表明AC可成功应用于所有患者。
降低起搏CC可在未选择的ICD导联系统上进行充分的ER检测以实现自动夺获验证。高压电击治疗对ER信号检测的影响需要进一步研究。
