Singer I, Hutchins G M, Mirowski M, Mower M M, Veltri E P, Guarnieri T, Griffith L S, Watkins L, Juanteguy J, Fisher S
J Am Coll Cardiol. 1987 Aug;10(2):382-8. doi: 10.1016/s0735-1097(87)80022-0.
The purpose of the present study was to examine at autopsy the effect of multiple defibrillations on the myocardium and the pathologic consequences of short- and long-term placement of the intravascular and interpericardial leads of the automatic implantable cardioverter-defibrillator. Twenty-five patients were examined at autopsy; 8 of them underwent lead implantation only and 17 received both leads and the automatic implantable cardioverter-defibrillator. Twelve patients (48%) died of ventricular tachycardia or ventricular fibrillation; seven (28%) died of other causes. Acute pericarditis occurred in all patients, resulting in a localized, progressive fibrosis around the apical patch lead without giving rise to pericardial restriction. Thrombus formation was associated with the superior vena cava spring electrode in four patients (17%) and the right ventricular rate-sensing electrode in one patient (4%). Asymptomatic pulmonary emboli occurred in two patients (8%). In one patient who underwent defibrillation 59 times, superior vena cava changes consisted of vein wall destruction, fibrosis and thrombus formation. Pathologic changes under the apical patch related to defibrillation were observed in seven patients; two of these had fewer than 5 defibrillations, one had 8 defibrillations and four had 21 to 74 defibrillations. These changes consisted of contraction band necrosis in four patients, vacuolar cytoplasmic clearing and loss of myocytes confined to the myocardium under the patch electrode in five patients who had multiple defibrillations. The observed pathologic changes were estimated to affect less than 2% of the total myocardial mass. Thus, the automatic implantable cardioverter-defibrillator lead system and multiple defibrillations result in localized myocardial injury confined to the tissue under the patch electrode.(ABSTRACT TRUNCATED AT 250 WORDS)
本研究的目的是通过尸检来检测多次除颤对心肌的影响，以及自动植入式心脏复律除颤器的血管内和心包内导联短期及长期放置的病理后果。对25例患者进行了尸检；其中8例仅接受了导联植入，17例同时接受了导联及自动植入式心脏复律除颤器。12例患者（48%）死于室性心动过速或心室颤动；7例（28%）死于其他原因。所有患者均发生急性心包炎，导致心尖补片导联周围局限性、进行性纤维化，但未引起心包缩窄。4例患者（17%）的上腔静脉弹簧电极出现血栓形成，1例患者（4%）的右心室速率感知电极出现血栓形成。2例患者（8%）出现无症状肺栓塞。在1例接受了59次除颤的患者中，上腔静脉改变包括静脉壁破坏、纤维化和血栓形成。7例患者观察到与除颤相关的心尖补片下方的病理改变；其中2例除颤次数少于5次，1例有8次除颤，4例有21至74次除颤。这些改变包括4例患者出现收缩带坏死，5例多次除颤患者的心肌细胞出现空泡样胞质清除和局限于心包补片电极下方心肌的细胞丢失。据估计，观察到的病理改变影响的心肌总量不到2%。因此，自动植入式心脏复律除颤器导联系统和多次除颤导致局限于心包补片电极下方组织的局部心肌损伤。（摘要截短至250字）
