Peters W, Hopp H, Bauer W R, Kowallik P, Meesmann M
Medizinische Klinik, Universität Würzburg.
Z Kardiol. 1995 Apr;84(4):296-300.
A 48-year-old man with dilative cardiomyopathy and a history of resuscitation due to ventricular fibrillation received an implantable cardioverter-defibrillator (ICD) with epicardial sensing and defibrillation electrodes in March 1990. An early battery depletion due to increased electrical leakage of a filter capacitor necessitated a generator exchange in July 1990. Subsequent inappropriate discharges occurred, but no underlying cause could be documented by history, clinical examination, Holter monitoring, and beepograms. Only 3 months later was it possible to demonstrate oversensing by repeated beepograms, and a new generator and transvenous sensing electrode were implanted in October 1991. Four months later, inappropriate shocks were suspected again. Once more, history, clinical examination, Holter monitoring, and beepograms were without pathological result. At follow-up, repeated beepograms during exercise demonstrated an oversensing, and an insulation defect of the newly implanted sensing electrode close to the edge of the generator could be documented on x-ray. Since replacement of generator and sensing electrode in July 1992 the patient is doing well. He received two appropriate shocks which were associated with presyncope. ICD therapy is very complex and therefore should only be performed in centers providing the necessary personal, apparative and logistic conditions.
一名48岁患有扩张型心肌病且有因室颤接受复苏病史的男性患者，于1990年3月植入了带有心外膜感知和除颤电极的植入式心律转复除颤器（ICD）。1990年7月，由于滤波电容器漏电增加导致电池过早耗尽，需要更换发生器。随后发生了不适当放电，但通过病史、临床检查、动态心电图监测和心音图均未发现潜在原因。仅3个月后，通过重复心音图才证实存在感知过度，1991年10月植入了新的发生器和经静脉感知电极。4个月后，再次怀疑出现不适当电击。病史、临床检查、动态心电图监测和心音图再次未显示病理结果。随访时，运动期间的重复心音图显示存在感知过度，X线检查发现新植入的靠近发生器边缘的感知电极存在绝缘缺陷。自1992年7月更换发生器和感知电极后，患者情况良好。他接受了两次与晕厥前期相关的适当电击。ICD治疗非常复杂，因此仅应在具备必要人员、设备和后勤条件的中心进行。
