Jung W, Manz M, Pfeiffer D, Tebbenjohanns J, Pizzulli L, Lüderitz B
Department of Cardiology, University of Bonn, Germany.
Pacing Clin Electrophysiol. 1993 Jan;16(1 Pt 2):198-201. doi: 10.1111/j.1540-8159.1993.tb01561.x.
Antiarrhythmic drugs are commonly used with the implantable cardioverter/defibrillator to treat recurrent ventricular tachyarrhythmias. Since various antiarrhythmic drugs have been reported to alter defibrillation threshold, an important question is whether the device will provide adequate energy for defibrillation during long-term follow-up and to what extent antiarrhythmic drug treatment will affect defibrillation energy requirements. To answer these questions, the defibrillation thresholds were determined in 20 patients using an epicardial patch-patch lead configuration at the time of implantation and at the time of pulse generator replacement. During a mean follow-up period of 24 +/- 6 months, the defibrillation threshold increased significantly from 14.2 +/- 3.7 joules to 18.3 +/- 5.5 joules in the entire group (P < 0.05). This increase in defibrillation threshold was due to a marked elevation of defibrillation energy requirements in the subgroup of patients taking amiodarone compared with patients receiving mexiletine. Based on these results it is mandatory to retest defibrillation threshold at any time of pulse generator replacement to guarantee continued effectiveness. In particular, if amiodarone treatment is initiated after implantation of a defibrillator, it is recommended to reevaluate defibrillation threshold to ensure an adequate margin of safety.
抗心律失常药物通常与植入式心脏复律除颤器一起使用，以治疗复发性室性快速性心律失常。由于已有报道称各种抗心律失常药物会改变除颤阈值，一个重要的问题是该设备在长期随访期间是否能提供足够的除颤能量，以及抗心律失常药物治疗会在多大程度上影响除颤能量需求。为了回答这些问题，在植入时和更换脉冲发生器时，采用心外膜贴片-贴片电极配置对20例患者的除颤阈值进行了测定。在平均24±6个月的随访期内，整个组的除颤阈值从14.2±3.7焦耳显著增加到18.3±5.5焦耳（P<0.05）。与接受美西律治疗的患者相比，服用胺碘酮的患者亚组中除颤能量需求显著升高，导致了除颤阈值的升高。基于这些结果，在更换脉冲发生器的任何时候重新测试除颤阈值以确保持续有效性是必不可少的。特别是，如果在植入除颤器后开始使用胺碘酮治疗，建议重新评估除颤阈值以确保足够的安全余量。
