Coltorti F, Bardy G H, Reichenbach D, Greene H L, Thomas R, Breazeale D G, Ivey T D
Circulation. 1986 Jun;73(6):1321-33. doi: 10.1161/01.cir.73.6.1321.
We compared two methods of delivering single damped sine-wave defibrillator pulses to the coronary sinus orifice in 20 dogs. Ten dogs had "unipolar" (coronary sinus to precordial disc) and 10 had "bipolar" (coronary sinus proximal to coronary sinus distal electrode) discharges. Delivered voltage, current, and energy were recorded during each pulse. Electrophysiologic testing was done before and 4 weeks after the procedure. Histologic examination of the atrioventricular groove was done at 1 mm serial sections. For the unipolar configuration a 200 J defibrillator pulse resulted in a peak voltage of 3370 +/- 125 V, a peak current of 21 +/- 4 A, and a delivered energy of 253 +/- 29 J as compared with 3010 +/- 99 V, 70 +/- 4 A, and 144 +/- 18 J, respectively, for the bipolar configuration (p less than .001). Three dogs (two with bipolar, one with unipolar pulses) had gross coronary sinus rupture and died from acute pericardial tamponade. In addition, irrespective of electrode configuration, all dogs showed microscopic rupture of the coronary sinus internal elastic membrane. Transmural atrial scarring occurred in all 10 dogs that received a unipolar pulse but in only two dogs that received a bipolar pulse (p = .0004). Unlike the atrium, injury to the left ventricle was limited in both groups. Similarly, injury to the periannular myocardium was inconsistent and not transmural in either group. No significant electrophysiologic changes were observed. With the present technique, unipolar rather than bipolar catheter-mediated defibrillator pulses result in transmural atrial injury that might prevent accessory pathway conduction. Regardless of electrode configuration, high-energy defibrillator pulses consistently cause some degree of coronary sinus rupture, most likely related to a barotraumatic mechanism.
我们在20只犬中比较了两种向冠状窦口输送单个衰减正弦波除颤脉冲的方法。10只犬接受“单极”（冠状窦至心前区圆盘）放电，10只犬接受“双极”（冠状窦近端电极至冠状窦远端电极）放电。在每个脉冲期间记录输送的电压、电流和能量。在手术前和术后4周进行电生理测试。对房室沟进行1毫米连续切片的组织学检查。对于单极配置，200 J除颤脉冲产生的峰值电压为3370±125 V，峰值电流为21±4 A，输送能量为253±29 J；相比之下，双极配置的峰值电压为3010±99 V，峰值电流为70±4 A，输送能量为144±18 J（p<0.001）。3只犬（2只接受双极脉冲，1只接受单极脉冲）发生冠状窦严重破裂并死于急性心包填塞。此外，无论电极配置如何，所有犬均显示冠状窦内弹性膜的微观破裂。接受单极脉冲的10只犬均出现透壁性心房瘢痕形成，而接受双极脉冲的犬中只有2只出现（p = 0.0004）。与心房不同，两组中左心室的损伤均有限。同样，两组中环周心肌的损伤均不一致且未透壁。未观察到明显的电生理变化。采用目前的技术，单极而非双极导管介导的除颤脉冲会导致透壁性心房损伤，这可能会阻止旁路传导。无论电极配置如何，高能除颤脉冲始终会导致一定程度的冠状窦破裂，最可能与气压伤机制有关。
