Oliveira Ricardo Gil, Madeira Francisco, Ferreira Ana Rita, Antunes Susana, Morais Carlos, Gil Victor
Serviço de Cardiologia, Hospital Fernando Fonseca, Amadora, Portugal.
Rev Port Cardiol. 2010 Apr;29(4):703-9.
An implantable cardioverter defibrillator (ICD) is designed to sense life-threatening ventricular arrhythmias and terminate them, either by rapid pacing or by delivering an electrical shock. Nowadays it is a proven therapy for both primary and secondary prevention of sudden cardiac death. The typical configuration of an ICD consists of a right ventricular sensing/defibrillator lead with two coils (one distal, located in the right ventricle, and one proximal, located at the superior vena cava-right atrium junction) and an active can, the so-called "ventricular triad". Although effective in the vast majority of patients, it could be argued that this is not the most rational arrangement in electrical terms, since the main shock vector is anteriorly displaced in relation to the greater portion of the left ventricular mass. We describe a case of an ICD defibrillation failure that was solved by placing an additional defibrillator lead in a tributary of the coronary sinus.
植入式心脏复律除颤器（ICD）旨在检测危及生命的室性心律失常，并通过快速起搏或电击予以终止。如今，它已被证实是预防心脏性猝死的一级和二级预防的有效疗法。ICD的典型配置包括一根带有两个线圈的右心室感知/除颤导线（一个位于右心室的远端线圈，一个位于上腔静脉-右心房交界处的近端线圈）和一个有源除颤罐，即所谓的“心室三联体”。尽管在绝大多数患者中有效，但从电学角度来看，这可能并非最合理的布局，因为主要电击向量相对于左心室大部分质量向前移位。我们描述了一例通过在冠状静脉窦的一条支流中额外放置一根除颤导线解决ICD除颤失败的病例。
