Adams D C, Heyer E J, Emerson R G, Spotnitz H M, Delphin E, Turner C, Berman M F
Department of Anesthesiology, Columbia-Presbyterian Medical Center, New York, N.Y.
J Thorac Cardiovasc Surg. 1995 Mar;109(3):565-73. doi: 10.1016/S0022-5223(95)70290-3.
During placement of implantable cardioverter-defibrillators, ventricular arrhythmias are induced to test the function of the devices. Although cerebral hypoperfusion and ischemic electroencephalographic changes occur in patients while implantable cardioverter-defibrillators are being tested, no investigation has assessed neurologic outcome in these patients. Nine patients having either implantation or change of an implantable cardioverter-defibrillator underwent neurologic examination and neuropsychometric tests before and after the operation. After induction of general anesthesia and insertion of implantable cardioverter-defibrillator leads (when needed), ventricular fibrillation, ventricular flutter, or ventricular tachycardia, was induced by means of programmed electrical stimulation. Implantable cardioverter-defibrillator testing continued until satisfactory lead placement was confirmed. The intraoperative electroencephalographic recording was analyzed for evidence of ischemic change. In all, an electroencephalogram was recorded during 50 periods of circulatory arrest. Mean duration of the arrest periods was 13.6 seconds. By means of conventional visual inspection of the raw electroencephalogram, high-amplitude rhythmic delta or theta, voltage attenuation, or loss of fast frequency activity was observed in 30 of the arrests. By means of an automated technique of electroencephalographic interpretation based on power spectral analysis, electroencephalographic changes were correctly identified in 26 of the arrests. The incidence of these electroencephalographic changes was dependent on the arrest duration. The mean interval from arrest onset to electroencephalographic change was 7.5 seconds (standard deviation +/- 1.8 seconds). In patients with electroencephalographic changes during multiple arrests, no downward trend in this interval was detected in later arrests and no evidence of persistent ischemic change was observed in electroencephalograms recorded after the conclusion of implantable cardioverter-defibrillator testing. Postoperative neurologic and neuropsychometric testing was completed in eight patients, none of whom exhibited a new neurologic deficit, exacerbation of a preexisting neurologic condition, or significant deterioration in neuropsychometric performance. We conclude that the brief arrest of cerebral circulation induced during insertion of an implantable cardioverter-defibrillator is not associated with permanent neurologic injury.
在植入式心脏复律除颤器植入过程中，会诱发室性心律失常以测试设备功能。尽管在测试植入式心脏复律除颤器时患者会出现脑灌注不足和缺血性脑电图改变，但尚无研究评估这些患者的神经学转归。9例接受植入式心脏复律除颤器植入或更换的患者在手术前后接受了神经学检查和神经心理测试。在诱导全身麻醉并插入植入式心脏复律除颤器导线（如有需要）后，通过程控电刺激诱发心室颤动、心室扑动或室性心动过速。持续进行植入式心脏复律除颤器测试，直至确认导线放置满意。分析术中脑电图记录以寻找缺血改变的证据。总共在50次循环骤停期间记录了脑电图。骤停期的平均持续时间为13.6秒。通过对原始脑电图进行传统的目视检查，在30次骤停中观察到高振幅节律性δ波或θ波、电压衰减或快速频率活动丧失。通过基于功率谱分析的脑电图自动解释技术，在26次骤停中正确识别出脑电图改变。这些脑电图改变的发生率取决于骤停持续时间。从骤停开始到脑电图改变的平均间隔为7.5秒（标准差±1.8秒）。在多次骤停期间出现脑电图改变的患者中，在随后的骤停中未检测到该间隔的下降趋势，并且在植入式心脏复律除颤器测试结束后记录的脑电图中未观察到持续缺血改变的证据。8例患者完成了术后神经学和神经心理测试，无一例出现新的神经功能缺损、原有神经疾病加重或神经心理表现显著恶化。我们得出结论，植入式心脏复律除颤器插入过程中诱发的短暂脑循环骤停与永久性神经损伤无关。
