Brachmann J, Hilbel T, Schöls W, Beyer T, Schweizer M, Sterns L, Karolyi L, Melichercik J, Freigang K D, Kübler W
Abteilung Innere Medizin III, Medizinische Universitätsklinik Heidelberg.
Herz. 1994 Oct;19(5):246-50.
The implantable cardioverter/defibrillator is gaining increasing significance in the therapy of life-threatening ventricular arrhythmias. Independently, the team of Mirowski and the team of Schuder started to develop experimental automatic implantable defibrillators in the seventies. In 1980, the first human implant of an automatic defibrillator was done by Levi Watkins together with the team of Mirowski in Baltimore, USA. Since 1989 implantable cardioverter/defibrillators exhibit multiple functions among which are high energy defibrillation therapy, low energy cardioversion, antitachycardia pacing, permanent and post therapy antibradycardia pacing, diagnostic counters, and device status parameters. This offers a markedly improved technical device to the patients. Evaluation of the patient's diagnostic counters provide a detailed overview about the patient's arrhythmia history and information for optimizing antitachycardia pacing therapy and additional antiarrhythmic drug therapy. The availability of non-thoractomy transvenous lead systems and biphasic shock forms allows the insertion of the device without open chest surgery and even without subcutaneous leads resulting in low mortality rates and an exclusively transvenous system. Single-lead unipolar devices are currently investigated in clinical trials. Future development of atrial sensing lead systems may further reduce inappropriate shock therapy triggered by sinus tachycardia or atrial tachyarrhythmias, e.g. atrial fibrillation, and may be used for dual chamber stimulation. Hemodynamic sensors for determining the severity of the arrhythmia are currently under experimental evaluation. Possible prognostic indications of ICD therapy in patients without a history of malignant arrhythmias are currently studied in several prospective trials. All new directions hold promise to expand and improve the use of ICDs in patients at risk for sudden cardiac death.
植入式心脏复律除颤器在危及生命的室性心律失常治疗中日益重要。米罗夫斯基团队和舒德团队在20世纪70年代各自独立开始研发实验性自动植入式除颤器。1980年，利瓦伊·沃特金斯与米罗夫斯基团队在美国巴尔的摩首次为人类植入自动除颤器。自1989年以来，植入式心脏复律除颤器具备多种功能，包括高能除颤治疗、低能心脏复律、抗心动过速起搏、永久及治疗后抗心动过缓起搏、诊断计数器以及设备状态参数。这为患者提供了显著改进的技术设备。评估患者的诊断计数器可详细了解患者的心律失常病史，并为优化抗心动过速起搏治疗及额外的抗心律失常药物治疗提供信息。非开胸经静脉导联系统和双相电击形式的应用，使得该设备无需开胸手术即可插入，甚至无需皮下导联，从而降低了死亡率，实现了完全经静脉系统。单极单导联设备目前正在临床试验中进行研究。心房感知导联系统的未来发展可能会进一步减少由窦性心动过速或房性快速心律失常（如心房颤动）引发的不适当电击治疗，并可用于双腔刺激。用于确定心律失常严重程度的血流动力学传感器目前正在进行实验评估。目前正在几项前瞻性试验中研究植入式心脏复律除颤器治疗对无恶性心律失常病史患者的可能预后指标。所有这些新方向都有望扩大并改善植入式心脏复律除颤器在心脏性猝死高危患者中的应用。
