Lubiński Andrzej, Lewicka-Nowak Ewa, Zienciuk Agnieszka, Królak Tomasz, Kempa Maciej, Pazdyga Anna, Raczak Grzegorz, Swiatecka Grazyna
II Department of Cardiovaascular Diseases, Institute of Cardiology, Medical Academy, Gdańsk, Poland.
Kardiol Pol. 2005 Sep;63(3):234-41; discussion 242-3.
The reduction of defibrillation threshold (DFT) in patients treated with an implantable cardioverter-defibrillator increases patients' safety and prolongs ICD battery life.
To evaluate the possibility of reducing the defibrillation threshold in ICDs with an active can and an additional atrial defibrillation coil instead of the typical intracardiac single-coil lead.
This study involved 138 patients (36 F and 102 M, mean age 54+/-15 years) including 62 subjects with dual-coil defibrillation lead (group A) and 76 ones with single-coil defibrillation lead (group B). No statistically significant differences with respect to age, left ventricular function, main disease or exacerbation of heart failure according to the NYHA functional class were observed between groups. The defibrillation threshold was measured using the DFT+ protocol.
No significant differences between groups were identified with respect to pacing and sensing parameters. The comparison of DFT values between the two studied groups revealed significant improvement (by 14% mean) of defibrillation efficacy in group A. In group A, the mean DFT was 9.8+/-4.6 J (3-20 J) and mean defibrillation resistance - 45+/-7 W (32-73 W), whereas in group B: 11.45+/-5.25 J (3-28 J) and 72+/-12.8 W (38-106 W), respectively. In 93% of patients from group A, DFT was below 15 J, in comparison to 81% of patients from group B (p=0.046). The odds ratio of a higher defibrillation threshold (ł15 J) in group A vs. group B was 0.3 (95% confidence interval: 0.09-0.98). The DFT reduction associated with modified ICD system use was independent of following clinical parameters: patient age, gender, main disease, end-diastolic left ventricular diameter, left ventricular ejection fraction, NYHA functional class and concomitant treatment with antiarrhythmic agents.
Modification of the electric field during defibrillation, achieved with the use of active-can ICDs with dual-coil defibrillation leads, allows a reduction of DFT by 14%. At the same time, it reduces the risk of a higher (> or =15 J) DFT by three times compared to patients with a standard single-coil defibrillation lead.
植入式心脏复律除颤器（ICD）治疗患者的除颤阈值（DFT）降低可提高患者安全性并延长ICD电池寿命。
评估使用有源罐和附加心房除颤线圈而非典型的心内单线圈导线来降低ICD除颤阈值的可能性。
本研究纳入138例患者（36例女性和102例男性，平均年龄54±15岁），其中62例使用双线圈除颤导线（A组），76例使用单线圈除颤导线（B组）。两组在年龄、左心室功能、主要疾病或根据纽约心脏协会（NYHA）功能分级的心力衰竭加重情况方面未观察到统计学显著差异。使用DFT+方案测量除颤阈值。
两组在起搏和感知参数方面未发现显著差异。两个研究组DFT值的比较显示，A组除颤效能有显著改善（平均提高14%）。A组的平均DFT为9.8±4.6 J（3 - 20 J），平均除颤电阻为45±7 W（32 - 73 W），而B组分别为11.45±5.25 J（3 - 28 J）和72±12.8 W（38 - 106 W）。A组93%的患者DFT低于15 J，而B组为81%（p = 0.046）。A组与B组相比，除颤阈值较高（≥15 J）的比值比为0.3（95%置信区间：0.09 - 0.98）。与改良ICD系统使用相关的DFT降低与以下临床参数无关：患者年龄、性别、主要疾病、舒张末期左心室直径、左心室射血分数、NYHA功能分级以及抗心律失常药物的联合治疗。
使用带有双线圈除颤导线的有源罐ICD在除颤期间改变电场，可使DFT降低14%。同时，与使用标准单线圈除颤导线的患者相比，其DFT较高（≥15 J）的风险降低了三倍。
