Licka M, Jahn L, Kelemen K, Voss F, Trappe K, Becker R, Bikou O, Hauck M, Koch M, Katus H A, Bauer A
Abteilung für Kardiologie, Angiologie und Pneumologie, Universitätsklinikum Heidelberg, Heidelberg, Germany.
Herzschrittmacherther Elektrophysiol. 2011 Dec;22(4):209-13. doi: 10.1007/s00399-011-0150-1. Epub 2011 Nov 13.
Intraoperative testing of implantable cardioverter-defibrillators (ICDs) is time consuming and associated with risks. In the present study, we elucidated whether the initial implantation of an ICD with high energy output makes intraoperative defibrillation threshold testing (DFTT) unnecessary even though antiarrhythmic (AA) therapy is needed in the future.
A total of 111 patients (94 men, 17 women) receiving an ICD with subsequent AA therapy (mexiletine, amiodarone, sotalol, flecainide) were analyzed retrospectively. DFT was performed during ICD implantation and after AA drug therapy. In a second step, DFT results from the study cohort were analyzed for implantation of virtual ICDs with either low (≤ 30 J, LOD), intermediate (34 J, IOD), or high energy output (36 J, HOD).
In the study cohort, all patients reached the safety margin (SM) of 10 J between DFT and maximal shock energy of the ICD. After loading of AA agents, 6 patients (12%) with a LOD, 3 patients (11%) with an IOD, and 3 (13%) patients with a HOD failed the 10 J SM. Using virtual ICDs, 6 (5.5%) patients with a LOD, 1 patient (1%) with an IOD, and no patients with a HOD would have failed the 10 J SM. After loading of AA agents, 18 patients (16%) with a virtual LOD, 12 patients (10.8%) with an IOD, and still 9 patients (8%) with a HOD would have failed the 10 J SM.
Our results demonstrate that the 10 J SM would have been achieved intraoperatively in all patients with virtual HOD ICDs. Thus, determination of the DFT during implantation does not seem to be obligatory. However, in patients receiving AA agents, DFT testing is still required.
植入式心脏复律除颤器（ICD）的术中测试耗时且存在风险。在本研究中，我们阐明了即使未来需要抗心律失常（AA）治疗，初始植入高能量输出的ICD是否可使术中除颤阈值测试（DFTT）不再必要。
回顾性分析了111例接受ICD并随后接受AA治疗（美西律、胺碘酮、索他洛尔、氟卡尼）的患者（94例男性，17例女性）。在ICD植入期间和AA药物治疗后进行DFT。第二步，分析研究队列中虚拟ICD（低能量输出≤30 J，LOD；中等能量输出34 J，IOD；高能量输出36 J，HOD）植入的DFT结果。
在研究队列中，所有患者在DFT与ICD最大电击能量之间均达到了10 J的安全 margin（SM）。加载AA药物后，6例（12%）LOD患者、3例（11%）IOD患者和3例（13%）HOD患者未达到10 J的SM。使用虚拟ICD时，6例（5.5%）LOD患者、1例（1%）IOD患者和无HOD患者未达到10 J的SM。加载AA药物后，18例（16%）虚拟LOD患者、12例（10.8%）IOD患者和仍有9例（8%）HOD患者未达到10 J的SM。
我们的结果表明，所有虚拟HOD ICD患者术中均可达到10 J的SM。因此，植入期间测定DFT似乎并非必需。然而，对于接受AA药物治疗的患者，仍需要进行DFT测试。
