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皮下植入式心脏除颤器出现高除颤阈值，原因是导线放置在了脂肪层。

High defibrillation threshold with a subcutaneous implantable cardiac defibrillator due to the lead having been positioned in the fat layer.

作者信息

Hirao Tatsuhiko, Nitta Junichi, Sato Akira, Takahashi Yoshihide, Goya Masahiko, Hirao Kenzo

机构信息

Department of Cardiovascular Medicine Japanese Red Cross Saitama Hospital Saitama Japan.

Department of Cardiovascular Medicine Tokyo Medical and Dental University Medical Hospital Bunkyo-ku Tokyo.

出版信息

J Arrhythm. 2018 Feb 8;34(2):198-200. doi: 10.1002/joa3.12033. eCollection 2018 Apr.

DOI:10.1002/joa3.12033
PMID:29657596
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5891406/
Abstract

A 46-year-old female with a body mass index of 38.9 kg/m and no organic heart disease underwent a subcutaneous implantable cardioverter-defibrillator implantation for secondary prevention of sudden cardiac death in the setting of idiopathic ventricular fibrillation. Defibrillation threshold (DFT) testing during implantation detected high shock impedance and high DFT. Fluoroscopy revealed subcoil fat between the lead and the sternum, which we suspected was the reason for the high shock impedance and high DFT. We repositioned the lead to a site just above the sternum and the shock impedance and DFT improved to within the respective normal ranges.

摘要

一名体重指数为38.9kg/m且无器质性心脏病的46岁女性，因特发性心室颤动行皮下植入式心律转复除颤器植入术以二级预防心源性猝死。植入过程中的除颤阈值（DFT）测试发现高电击阻抗和高DFT。荧光透视显示导线与胸骨之间有皮下脂肪，我们怀疑这是高电击阻抗和高DFT的原因。我们将导线重新放置到胸骨上方的一个位置，电击阻抗和DFT改善到各自的正常范围内。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b167/5891406/3f4777f81bc2/JOA3-34-198-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b167/5891406/7d0309cec657/JOA3-34-198-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b167/5891406/3f4777f81bc2/JOA3-34-198-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b167/5891406/7d0309cec657/JOA3-34-198-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b167/5891406/3f4777f81bc2/JOA3-34-198-g002.jpg

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本文引用的文献

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2
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JACC Clin Electrophysiol. 2017 Apr;3(4):405-414. doi: 10.1016/j.jacep.2016.10.016. Epub 2017 Mar 1.
3
Long-Term Clinical Outcomes of Subcutaneous Versus Transvenous Implantable Defibrillator Therapy.
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4
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