Spurrell Philip, Gandhi Manish, Rinaldi Christopher A
Derriford Hospital, Plymouth, UK.
Pacing Clin Electrophysiol. 2006 Mar;29(3):334-6. doi: 10.1111/j.1540-8159.2006.00344.x.
We describe the case of a 59-year-old gentleman with severe dilated cardiomyopathy requiring implantation of a dual-chamber biventricular implantable cardioverter-defibrillator (ICD). High defibrillation thresholds (DFT) were encountered at implant with an inadequate defibrillation safety margin. Testing of all possible shock vectors/polarities with and without the SVC coil and optimization of the distal RV coil position all proved inadequate. A satisfactory defibrillation safety margin was achieved following placement of a second lead in the coronary sinus to enable biventricular defibrillation. This case highlights an additional strategy for combating high DFTs and is an option even in dual-chamber biventricular ICD systems.
我们描述了一名59岁男性患者的病例，该患者患有严重扩张型心肌病，需要植入双腔双心室植入式心脏复律除颤器（ICD）。植入时遇到高除颤阈值（DFT），除颤安全裕度不足。在有和没有上腔静脉（SVC）线圈的情况下测试所有可能的电击向量/极性，以及优化右心室（RV）远端线圈位置均证明不足。在冠状窦放置第二根导线以实现双心室除颤后，获得了令人满意的除颤安全裕度。该病例突出了一种应对高DFT的额外策略，即使在双腔双心室ICD系统中也是一种选择。
