Matassini Maria Vittoria, Healey Jeff S
Polytechnic University of Marche, Ancona, Italy.
Curr Treat Options Cardiovasc Med. 2013 Aug;15(4):497-505. doi: 10.1007/s11936-013-0244-7.
In the 30 years since its introduction, implantable cardioverter defibrillator (ICD) hardware and programming has evolved greatly. Coupled with a better understanding of how patient factors and anti-arrhythmic drug therapy affect ICD function, these changes have resulted in a modern ICD system which is highly effective at terminating ventricular arrhythmias. This has led to a marked decrease in the conduct of intraoperative defibrillation testing. Still, clinicians are faced with patients who have had unsuccessful intraoperative defibrillation testing or who have experienced one or more failed clinical shocks for ventricular arrhythmias. Thus, clinicians caring for ICD patients must understand the expected performance of modern ICD systems, understand the issues with intraoperative defibrillation testing, and have a strategy for dealing with patients when their ICD has failed to terminate a clinical or induced ventricular arrhythmia. This review will focus on the clinical approach to such patients, including trouble-shooting and system revision.
自植入式心脏复律除颤器（ICD）问世30年来，其硬件和编程技术有了很大发展。再加上对患者因素和抗心律失常药物治疗如何影响ICD功能有了更深入的了解，这些变化造就了一种现代ICD系统，它在终止室性心律失常方面非常有效。这使得术中除颤测试的实施显著减少。尽管如此，临床医生仍面临着术中除颤测试未成功或经历过一次或多次室性心律失常临床电击失败的患者。因此，负责ICD患者的临床医生必须了解现代ICD系统的预期性能，了解术中除颤测试的问题，并制定一种策略来处理ICD未能终止临床或诱发的室性心律失常的患者。本综述将重点关注此类患者的临床处理方法，包括故障排除和系统修订。
