Larsen Jacob Moesgaard, Heath Finn P, Riahi Sam, Holm Katja, Johansen Martin B, Hjortshøj Søren P, Thøgersen Anna M
Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, PO Box 365, 9000, Aalborg, Denmark.
Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
J Interv Card Electrophysiol. 2019 Jan;54(1):65-72. doi: 10.1007/s10840-018-0443-y. Epub 2018 Sep 18.
Implantable cardioverter defibrillators (ICDs) can treat life-threatening tachyarrhythmia with high-voltage shocks. The aims were to compare the efficacy of single and dual coil shock vectors in modern ICDs and to identify predictors of shock failure.
This is a single-center paired randomized study including 216 patients with mixed indications and ICDs from four manufacturers. All patients underwent two implant defibrillation tests using single and dual coil vectors with the test order randomized. Tested shock energy differed slightly between manufacturers because of differences in device programmability: first shock approximately 15 J below maximal output-if failed, second shock approximately 10 J below maximal output-if failed, third shock at maximal output.
First shock success rate was 399/432 (92.4%). Comparing single and dual coil vectors, no differences were seen in first shock efficacy (91.7% vs. 93.1%, P = 0.629) or lowest tested succesfully stored energy (27.2 J vs. 27.1 J, P = 0.620). All successive internal shocks failed in 4/432 (0.9%) of inductions requiring external rescue shocks to restore circulation. Multivariate predictors of first shock failure were QRS duration (relative risk 0.81 per 10 ms, P = 0.001), amiodarone treatment (relative risk 3.30, P = 0.003), and body height (relative risk 1.70 per 10 cm, P = 0.019).
Implant defibrillation testing of modern intravenous ICD systems demonstrates high shock efficacy with no difference between single and dual coil vectors.
植入式心脏复律除颤器（ICD）可通过高压电击治疗危及生命的快速性心律失常。本研究旨在比较现代ICD中单线圈和双线圈电击向量的疗效，并确定电击失败的预测因素。
这是一项单中心配对随机研究，纳入了来自四个制造商的216例有多种适应证且植入ICD的患者。所有患者均接受两次植入式除颤测试，分别使用单线圈和双线圈向量，测试顺序随机。由于设备可编程性的差异，不同制造商测试的电击能量略有不同：首次电击为最大输出以下约15J；若失败，第二次电击为最大输出以下约10J；若仍失败，第三次电击为最大输出。
首次电击成功率为399/432（92.4%）。比较单线圈和双线圈向量，首次电击疗效（91.7%对93.1%，P = 0.629）或最低成功存储测试能量（27.2J对27.1J，P = 0.620）均无差异。在4/432（0.9%）的诱发中，所有连续的内部电击均失败，需要外部抢救电击来恢复循环。首次电击失败的多因素预测因素为QRS波时限（每10ms相对风险0.81，P = 0.001）、胺碘酮治疗（相对风险3.30，P = 0.003）和身高（每10cm相对风险1.70，P = 0.019）。
现代静脉ICD系统的植入式除颤测试显示电击疗效高，单线圈和双线圈向量之间无差异。
