Radbill Andrew E, Triedman John K, Berul Charles I, Walsh Edward P, Alexander Mark E, Webster Gregory, Cecchin Frank
Department of Pediatrics, Vanderbilt University School of Medicine, and the Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee 37232-9119, USA.
Pacing Clin Electrophysiol. 2012 Dec;35(12):1487-93. doi: 10.1111/j.1540-8159.2012.03519.x. Epub 2012 Sep 14.
Adaptation of implantable cardioverter defibrillator (ICD) systems to the needs of pediatric and congenital heart patients is problematic due to constraints of vascular and thoracic anatomy. An improved understanding of the defibrillation energy and postshock pacing requirements in such patients may help direct more tailored ICD therapy. We describe the first prospective evaluation of defibrillation threshold (DFT) and postshock rhythm in this population.
We prospectively studied patients ≤ 60 kg at time of ICD intervention. DFTs were obtained using a binary search protocol with three VF inductions. Postshock pacing was programmed using a stepwise protocol, lowering the rate prior to each VF induction.
Twenty patients were enrolled: 11 had channelopathy, five congenital heart disease, and four cardiomyopathy. The median age was 16 years, median weight 48 kg. Twelve patients had a transvenous high-voltage coil; eight had pericardial +/- subcutaneous coil(s). Median DFT was 7 J (range 3-31 J); 19/20 patients had DFT ≤ 15 J and all patients <25 kg had DFT ≤ 9 J (n = 6). There was no difference in DFT between patients with transvenous versus pericardial +/- subcutaneous coils (median 7 J vs 6 J, P = 0.59). No patient with normal atrioventricular conduction prior to defibrillation required postshock pacing (n = 16). There were no adverse events.
These data suggest that many pediatric ICD patients have low DFTs and adequate postshock escape rhythm. This may help determine appropriate parameters for future design of pediatric-specific ICDs.
由于血管和胸廓解剖结构的限制，使植入式心脏复律除颤器（ICD）系统适应儿科和先天性心脏病患者的需求存在问题。更好地了解此类患者的除颤能量和电击后起搏需求可能有助于指导更具针对性的ICD治疗。我们描述了对该人群除颤阈值（DFT）和电击后节律的首次前瞻性评估。
我们前瞻性地研究了ICD干预时体重≤60kg的患者。使用二元搜索协议进行三次室颤诱发来获得DFT。采用逐步协议对电击后起搏进行编程，在每次室颤诱发前降低起搏频率。
共纳入20例患者：11例患有通道病，5例患有先天性心脏病，4例患有心肌病。中位年龄为16岁，中位体重48kg。12例患者有经静脉高压线圈；8例有心包±皮下线圈。中位DFT为7J（范围3 - 31J）；19/20例患者DFT≤15J，所有体重<25kg的患者DFT≤9J（n = 6）。经静脉线圈与心包±皮下线圈患者的DFT无差异（中位值7J对6J，P = 0.59）。除颤前房室传导正常的患者均无需电击后起搏（n = 16）。无不良事件发生。
这些数据表明，许多儿科ICD患者的DFT较低且电击后逸搏节律良好。这可能有助于确定未来儿科专用ICD设计的合适参数。
