Reid P R, Mirowski M, Mower M M, Platia E V, Griffith L S, Watkins L, Bach S M, Imran M, Thomas A
Am J Cardiol. 1983 Jun;51(10):1608-13. doi: 10.1016/0002-9149(83)90195-9.
An R-wave synchronous implantable automatic cardioverter-defibrillator (IACD) was evaluated in 12 patients with repeated episodes of cardiac arrest who remained refractory to medical and surgical therapy. Seven men and 5 women, average age 61 years, surgically received a complete IACD system. Coronary artery disease was found in 11 and the prolonged Q-T syndrome in 1. The average ejection fraction was 34%, and 6 patients had severe congestive heart failure (New York Heart Association class III or IV). The IACD is a completely implantable unit consisting of 2 bipolar lead systems. One system uses a lead in the superior vena cava and on the left ventricular apex through which the cardioverting pulse is delivered. The second system employs a close bipolar lead implanted in the ventricle for sensing rate. After the onset of ventricular tachycardia or fibrillation, the IACD automatically delivers approximately 25 J. Postoperative electrophysiologic study in 10 and spontaneous ventricular tachycardia in 1 patient demonstrated appropriate IACD function and successful conversion in all with an average of 18 +/- 4 seconds. The induced arrhythmias were ventricular tachycardia (160 to 300 beats/min) in 9 and ventricular fibrillation in 1. These data demonstrate that ventricular tachycardia, not ventricular fibrillation, was the predominant rhythm induced during programmed ventricular stimulation in these survivors of cardiac arrest and that the IACD effectively responded to a wide range of ventricular tachycardia rates as well as ventricular fibrillation. Use of the IACD offers an effective means of therapy for some patients who otherwise may not have survived.
对12例反复发生心脏骤停且对药物和手术治疗均无效的患者进行了R波同步植入式自动心脏复律除颤器（IACD）评估。其中7名男性和5名女性，平均年龄61岁，通过手术植入了完整的IACD系统。11例患者患有冠状动脉疾病，1例患有长QT综合征。平均射血分数为34%，6例患者患有严重充血性心力衰竭（纽约心脏协会III或IV级）。IACD是一个完全可植入的装置，由2个双极导联系统组成。一个系统使用一根位于上腔静脉和左心室心尖的导联，通过该导联输送复律脉冲。第二个系统采用一根植入心室的紧密双极导联来感知心率。在室性心动过速或颤动发作后，IACD自动输送约25焦耳的能量。10例患者术后进行了电生理研究，1例患者出现自发性室性心动过速，结果显示IACD功能正常，所有患者均成功转复，平均转复时间为18±4秒。诱发的心律失常中，9例为室性心动过速（160至300次/分钟），1例为心室颤动。这些数据表明，在这些心脏骤停幸存者的程控心室刺激过程中，诱发的主要节律是室性心动过速而非心室颤动，并且IACD对广泛的室性心动过速心率以及心室颤动均能有效响应。使用IACD为一些原本可能无法存活的患者提供了一种有效的治疗手段。
