Guertin Danette, Faheem Osman, Ling Thea, Pelletier Glenn, McComas David, Yarlagadda Ravi K, Clyne Christopher, Kluger Jeffrey
Section of Heart Rhythm Management, Henry Low Heart Center, Hartford Hospital, Hartford, Connecticut 06102, USA.
Pacing Clin Electrophysiol. 2007 Jun;30(6):734-9. doi: 10.1111/j.1540-8159.2007.00743.x.
The objective was to determine the effect of electromagnetic interference (EMI) in patients undergoing gastrointestinal endoscopy. The implantable cardioverter-defibrillator (ICD) is the primary therapeutic modality for patients at risk for sudden cardiac death. One potential problem with ICDs is interactions with electrical devices and medical procedures causing EMI or triggering arrhythmic events. Endoscopy frequently employs electrocautery (EC) for diagnosis and treatment of gastrointestinal diseases. Current guidelines advise inactivating ICDs before any surgical procedure. There is limited information on management of ICDs during endoscopy with or without EC. We prospectively evaluated patients with ICDs undergoing endoscopic procedures at our institution.
Forty-one ICD patients underwent 52 gastrointestinal endoscopies over 17 months. The mean age of the population was 66 years (51-83). There were 28 men and 13 women. Thirteen patients had single chamber devices, 25 had dual chamber devices, and 2 had biventricular ICDs. The mean tachyarrhythmia detection rate programmed was 164.7 bpm (125-188). Eighteen procedures (43.9%) required biopsy, coagulation, or polypectomy. Of these, 10 (55%) required the use of EC. Only unipolar EC with mean current 19.6 mA was used. All ICDs were programmed to detection-only with therapies off. Sensitivity was left at nominal programmed settings. Post procedure interrogation showed no detection of EMI or tachyarrhythmic events.
Our study shows no EMI or arrhythmic events triggered during endoscopic procedures in patients with pectorally implanted transvenous ICDs. Routine practice of programming ICDs off for gastrointestinal procedures may not be necessary. However, larger studies are needed before change in current recommendations.
目的是确定电磁干扰（EMI）对接受胃肠内镜检查患者的影响。植入式心脏复律除颤器（ICD）是有心脏性猝死风险患者的主要治疗方式。ICD的一个潜在问题是与电气设备和医疗程序相互作用，导致EMI或引发心律失常事件。内镜检查经常使用电灼术（EC）来诊断和治疗胃肠疾病。当前指南建议在任何外科手术前停用ICD。关于在内镜检查期间（无论是否使用EC）管理ICD的信息有限。我们对在本机构接受内镜检查的ICD患者进行了前瞻性评估。
41例ICD患者在17个月内接受了52次胃肠内镜检查。患者的平均年龄为66岁（51 - 83岁）。其中男性28例，女性13例。13例患者使用单腔设备，25例使用双腔设备，2例使用双心室ICD。编程的平均快速心律失常检测率为164.7次/分钟（125 - 188次/分钟）。18例操作（43.9%）需要活检、凝血或息肉切除术。其中，10例（55%）需要使用EC。仅使用了平均电流为19.6 mA的单极EC。所有ICD均编程为仅检测且关闭治疗功能。灵敏度保持在标称编程设置。术后问询显示未检测到EMI或快速心律失常事件。
我们的研究表明，对于胸前植入经静脉ICD的患者，在内镜检查过程中未触发EMI或心律失常事件。对于胃肠检查常规将ICD关机的做法可能没有必要。然而，在改变当前建议之前，还需要进行更大规模的研究。
