Bastian Dirk, Kracker Stefan, Pauschinger Matthias, Göhl Konrad
Division of Cardiology and Electrophysiology, Medizinische Klinik 8, Klinikum Nürnberg Süd, Breslauer Str. 201, 90471, Nuremberg, Germany.
Herzschrittmacherther Elektrophysiol. 2013 Jun;24(2):125-30. doi: 10.1007/s00399-013-0267-5. Epub 2013 Jun 7.
The need for implantable cardioverter-defibrillator (ICD) defibrillation testing (DT) and subsequent intraoperative system modifications is discussed controversially. The study's goal was to prove that consequent abdication of intraoperative DT does not impair defibrillation efficacy and does not increase the rate of postoperative system revisions.
In a prospective single-center observational study, 609 out of 648 consecutive patients underwent transvenous ICD implantation (left-sided, active can, dual coil lead, and biphasic shock waveform) waiving intraoperative DT. Defibrillation efficacy was validated prior to hospital discharge (PHD) by applying two 10 J safety margin (SM) shocks.
Following "schockless" implantation 580 out of 609 patients (95.2 %) met a 10 J SM with default programming. Shock path reversal provided 10 J SM in 13 out of 29 cases with initially failed DT. In four patients (0.7 %) maximum energy shocks were ineffective. There was no morbidity or mortality related to DT. The total rate of surgical ICD revisions was 1.8 %.
Routine ICD implantation without intraoperative DT does not lead to an increased rate of postoperative system modifications and does not decrease defibrillation efficacy as tested PHD.
关于植入式心脏复律除颤器（ICD）除颤测试（DT）的必要性以及随后的术中系统修改存在争议。本研究的目的是证明术中放弃DT不会损害除颤效果，也不会增加术后系统修订率。
在一项前瞻性单中心观察性研究中，648例连续患者中有609例接受了经静脉ICD植入（左侧、主动电极罐、双线圈导线和双相电击波形），放弃了术中DT。在出院前（PHD）通过施加两次10 J安全边际（SM）电击来验证除颤效果。
在“无电击”植入后，609例患者中有580例（95.2%）在默认编程下达到了10 J SM。在最初DT失败的29例病例中，有13例通过电击路径反转达到了10 J SM。4例患者（0.7%）最大能量电击无效。没有与DT相关的发病率或死亡率。手术ICD修订的总发生率为1.8%。
不进行术中DT的常规ICD植入不会导致术后系统修改率增加，也不会如PHD测试那样降低除颤效果。
