Weretka Slawomir, Michaelsen Jochen, Becker Ruediger, Karle Christoph A, Voss Frederik, Hilbel Thomas, Osswald Brigitte R, Bahner Malte L, Senges Julia C, Kuebler Wolfgang, Schoels Wolfgang
Department of Cardiology, Electrophysiology, University Hospital Heidelberg, Bergheimerstr. 58, 69115 Heidelberg, Germany.
Pacing Clin Electrophysiol. 2003 Jan;26(1 Pt 1):65-70. doi: 10.1046/j.1460-9592.2003.00152.x.
Modern dual chamber ICD systems are able to overcome various sensing problems. However, improvement of their performance is still required. The aim of this study was to assess the sensing function in 101 consecutive patients (84 men, 17 women; mean age 63 +/- 12 years; mean follow-up 24 +/- 4 months) implanted with dual chamber defibrillators and integrated (IB) or dedicated bipolar (DB) lead systems. Follow-up data were analyzed for the presence of ventricular oversensing. Oversensing occurred in 25 (25%) patients, significantly more frequent in patients implanted with IB compared to DB lead systems (21/52 vs 4/49, P = 0.0002). Patients with cardiomyopathies (CMs) were more prone to sensing malfunctions than patients with no CM (12/30 vs 13/71, P = 0.04). T wave oversensing (n = 14), respirophasic ventricular oversensing (n = 4), and P wave oversensing (n = 6) were the most common pitfalls of ventricular sensing. P wave oversensing was unique to the IB lead system. CT scans performed in these patients disclosed the position of the RV coil to be proximal to the tricuspid area. Four patients received inappropriate ICD shocks due to oversensing. In all but two patients who received lead revision, oversensing was resolved by noninvasive means.
(1) ventricular oversensing is a common problem occurring in up to 25% of patients with dual chamber ICDs; (2) P wave oversensing is a ventricular sensing problem affecting function of 11% of dual chamber devices with IB lead systems; (3) IB leads are significantly more susceptible to T wave and P wave oversensing than DB leads; and (4) patients with cardiomyopathies are more prone to oversensing than patients with other heart diseases.
现代双腔植入式心律转复除颤器（ICD）系统能够克服各种感知问题。然而，其性能仍需改进。本研究旨在评估101例连续植入双腔除颤器并采用集成式（IB）或专用双极（DB）导联系统的患者（84例男性，17例女性；平均年龄63±12岁；平均随访24±4个月）的感知功能。分析随访数据以确定是否存在心室感知过度。25例（25%）患者出现感知过度，与DB导联系统相比，植入IB导联系统的患者中感知过度更为频繁（21/52对4/49，P = 0.0002）。患有心肌病（CM）的患者比无CM的患者更容易出现感知故障（12/30对13/71，P = 0.04）。T波感知过度（n = 14）、呼吸相心室感知过度（n = 4）和P波感知过度（n = 6）是心室感知最常见的问题。P波感知过度是IB导联系统特有的。对这些患者进行的CT扫描显示右心室线圈位于三尖瓣区域近端。4例患者因感知过度接受了不适当的ICD电击。除2例接受导联修正的患者外，所有患者的感知过度均通过非侵入性方法得到解决。
（1）心室感知过度是双腔ICD患者中高达25%出现的常见问题；（2）P波感知过度是影响11%采用IB导联系统的双腔设备功能的心室感知问题；（3）IB导联比DB导联更容易出现T波和P波感知过度；（4）患有心肌病的患者比其他心脏病患者更容易出现感知过度。
