Frame R, Brodman R, Furman S, Gross J, Kim S G, Ferrick K, Roth J, Hollinger I, Fisher J D
Department of Cardiothoracic Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York 10467.
Pacing Clin Electrophysiol. 1993 Jan;16(1 Pt 2):208-12. doi: 10.1111/j.1540-8159.1993.tb01563.x.
From March 1982 to May 1, 1992, 105 consecutive patients underwent initial implant of cardioverter defibrillators (ICD) at our institution. Twenty-nine patients (23 male and 6 female, average ejection fraction 32.24%) with ICD systems implanted via thoracotomy and either intra- or extrapericardial patches, had one or more revisions including 56 generator changes or staged implant procedures, three patch revisions, one patch lead fracture without revision, and one sensing lead revision. The time between pulse generator revisions averaged 19.5 months. Initial defibrillation threshold mean was 12.8 joules (n = 25); at first revision, 14.46 joules (n = 29), (P = NS); by fifth revision, 15.0 joules (n = 2), (P = NS). One patch was noted to be crinkled at 70 months; one patch had migrated by 39 months, and two patch leads had fractured at the costal margin by 69 and 90 months. One patient with marginal defibrillation thresholds had an additional patch placed at revision to an upgraded ICD unit. Once acceptable defibrillation threshold (DFT) is obtained, the long-term intrapericardial DFT remains stable unless a specific problem occurs. As a small, nonstatistically significant increase in DFT may occur, caution must be exercised in patients with marginal DFTs.
从1982年3月至1992年5月1日，在我们机构有105例连续患者首次植入心脏复律除颤器（ICD）。29例患者（23例男性和6例女性，平均射血分数32.24%）通过开胸手术植入ICD系统，并使用心包内或心包外补片，进行了一次或多次修订，包括56次发生器更换或分期植入手术、3次补片修订、1次未修订的心包补片导线断裂和1次感知导线修订。脉冲发生器修订之间的平均时间为19.5个月。初始除颤阈值平均为12.8焦耳（n = 25）；第一次修订时为14.46焦耳（n = 29），（P = 无显著性差异）；到第五次修订时为15.0焦耳（n = 2），（P = 无显著性差异）。发现一个补片在70个月时出现褶皱；一个补片在39个月时发生移位，两个补片导线在69个月和90个月时在肋缘处发生断裂。一名除颤阈值临界的患者在修订时为升级的ICD装置额外放置了一个补片。一旦获得可接受的除颤阈值（DFT），除非出现特定问题，长期的心包内DFT保持稳定。由于DFT可能会出现小的、无统计学意义的增加，对于DFT临界的患者必须谨慎。
