Levine P A, Barold S S, Fletcher R D, Talbot P
J Am Coll Cardiol. 1983 Jun;1(6):1413-22. doi: 10.1016/s0735-1097(83)80044-8.
Six cases are presented in which a transient or chronic rise in the stimulation threshold of a permanently implanted unipolar pacemaker resulted in the loss of effective pacing after therapeutic defibrillation or cardioversion. Although damage to the pulse generator may still occur, leading to a loss of function as demonstrated in a seventh patient, improvements in the internal protection circuits of the present generation of pacemakers makes this less likely while possibly predisposing to endocardial burns and increased fibrosis at the electrode-endocardial interface. The theoretical explanations for this phenomenon are discussed, along with recommendations for the prospective and retrospective management of the pacemaker patient who requires defibrillation or cardioversion.
本文介绍了6例永久性植入单极起搏器刺激阈值出现短暂或慢性升高的病例，这些病例在治疗性除颤或心脏复律后导致有效起搏丧失。尽管仍可能发生脉冲发生器损坏，如第7例患者所示导致功能丧失，但当代起搏器内部保护电路的改进降低了这种可能性，同时可能易引发心内膜烧伤以及电极 - 心内膜界面处纤维化增加。文中讨论了这一现象的理论解释，以及对需要除颤或心脏复律的起搏器患者进行前瞻性和回顾性管理的建议。
