Antunes M L, Spotnitz H M, Livelli F D, Steinberg J S, Bigger J T
Department of Surgery, Columbia University College of Physicians and Surgeons, New York, NY.
Ann Thorac Surg. 1988 Mar;45(3):315-8. doi: 10.1016/s0003-4975(10)62471-x.
To evaluate the effect of repeated induction of ventricular tachycardia or ventricular fibrillation, or both, in patients with poor left ventricular function, we performed intraoperative two-dimensional echocardiography in 6 patients undergoing implantation of the automatic implantable cardioverter/defibrillator. Changes in left ventricular ejection fraction in sinus rhythm were assessed before the first inducible ventricular arrhythmia and after a mean of 6 +/- 1.9 (SD) episodes of ventricular tachycardia or ventricular fibrillation. During the procedure no significant change in mean ejection fraction was observed (28 +/- 14 versus 27 +/- 17%). Only 1 of the 6 patients studied had a change in ejection fraction greater than 3% (a decrease from 20 to 11%). In an overall clinical series of 38 primary implants or generator changes (including electrophysiological testing) in 29 patients, 1 patient recovered after postoperative inotropic support and 1 died of acute postoperative ischemic heart failure. We conclude that ventricular arrhythmias induced during automatic implantable cardioverter/defibrillator implantation have no immediate deleterious effects on ejection fraction in most patients with compromised left ventricular function and without ongoing ischemia.
为评估反复诱发室性心动过速或室颤，或两者兼而有之，对左心室功能不全患者的影响，我们对6例接受植入式自动心脏复律除颤器植入术的患者进行了术中二维超声心动图检查。在首次可诱发性室性心律失常前以及平均6±1.9（标准差）次室性心动过速或室颤发作后，评估窦性心律时左心室射血分数的变化。在手术过程中，未观察到平均射血分数有显著变化（28±14%对27±17%）。所研究的6例患者中只有1例射血分数变化大于3%（从20%降至11%）。在29例患者进行的38次初次植入或发生器更换（包括电生理测试）的总体临床系列中，1例患者术后经正性肌力支持后恢复，1例死于术后急性缺血性心力衰竭。我们得出结论，在植入式自动心脏复律除颤器植入过程中诱发的室性心律失常，对大多数左心室功能受损且无持续性缺血的患者的射血分数没有立即的有害影响。
