Pluymaekers Nikki A H A, Dudink Elton A M P, Boersma Lucas, Erküner Ömer, Gelissen Marloes, van Dijk Vincent, Wijffels Maurits, Dinh Trang, Vernooy Kevin, Crijns Harry J, Balt Jippe, Luermans Justin G L M
Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands.
Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands.
Pacing Clin Electrophysiol. 2018 Oct;41(10):1336-1340. doi: 10.1111/pace.13467. Epub 2018 Aug 28.
Atrial tachyarrhythmias are common in patients with cardiac implantable electronic devices (CIEDs). Restoration of sinus rhythm by external electrical cardioversion (eECV) is frequently used to alleviate symptoms and to ensure optimal device function.
To evaluate the safety of eECV in patients with contemporary CIEDs and to assess the need for immediate device interrogation after eECV.
We conducted a retrospective observational study of 229 patients (27.9% female, age 69 ± 10 years) with a CIED (104 pacemakers, 69 implantable cardioverter defibrillators, and 56 biventricular devices) who underwent eECV between 2008 and 2016 in two centers. Data from device interrogation before eECV, immediately afterwards, and at first follow-up (FU) after eECV were collected. CIED-related complications and adverse events during and after eECV were recorded.
No significant differences between right atrial (RA) and right ventricular (RV) sensing or threshold values before eECV, immediately afterwards, or at FU were observed. A small yet significant decrease was observed in RA and RV impedance immediately after eECV (484 Ω vs 462 Ω, P < 0.001 and 536 Ω vs 514 Ω, P < 0.001, respectively). The RV impedance did not recover to the baseline value (538 Ω vs 527 Ω, P = 0.02). The impedance changes were without clinical consequences. No changes in left ventricular lead threshold or impedance values were measured. No CIED-related complications or adverse events were documented following eECV.
eECV in patients with contemporary CIEDs is safe. There seems to be no need for immediate device interrogation after eECV.
心房快速性心律失常在心脏植入式电子设备（CIED）患者中很常见。通过外部电复律（eECV）恢复窦性心律常用于缓解症状并确保设备的最佳功能。
评估当代CIED患者进行eECV的安全性，并评估eECV后立即进行设备问询的必要性。
我们对2008年至2016年期间在两个中心接受eECV的229例CIED患者（女性占27.9%，年龄69±10岁）进行了一项回顾性观察研究。这些患者包括104例起搏器、69例植入式心律转复除颤器和56例双心室设备。收集了eECV前、eECV后立即以及eECV后首次随访（FU）时的设备问询数据。记录了eECV期间及之后与CIED相关的并发症和不良事件。
在eECV前、eECV后立即或FU时，右心房（RA）和右心室（RV）感知或阈值之间未观察到显著差异。eECV后立即观察到RA和RV阻抗有小幅但显著的下降（分别为从484Ω降至462Ω，P<0.001；从536Ω降至514Ω，P<0.××1）。RV阻抗未恢复到基线值（538Ω对527Ω，P = 0.02）。阻抗变化无临床后果。未测量左心室导线阈值或阻抗值的变化。eECV后未记录到与CIED相关的并发症或不良事件。
当代CIED患者进行eECV是安全的。eECV后似乎无需立即进行设备问询。
