Neuzner J, Pitschner H F, König S, Stöhring R, Schlepper M
Kerckhoff-Klinik, Institut der Max-Planck-Gesellschaft, Bad Nauheim.
Z Kardiol. 1993 Aug;82(8):459-65.
A cardioverter/defibrillator that is capable of storing endocardial electrograms before and after electrical device therapy was implanted in 29 patients presenting drug refractory ventricular arrhythmias. During a follow-up period of 7.5 +/- 4.6 months 15/29 patients (51%) experienced a total number of 112 pulse generator discharges. In 104 arrhythmia episodes the stored electrogram was analyzed. Morphological criterias of the stored electrogram as detectable P-waves and changes in the QRS-morphology during tachycardia compared to sinus rhythm served for classification of the documented arrhythmia. The analysis of the stored electrogram established a definitive diagnosis of the arrhythmia and allows to distinguish supraventricular arrhythmias from ventricular arrhythmias in every episode. 72/104 (69.2%) of the discharges were classified as appropriate, 32/104 (30.8%) of the device discharges were not appropriate and caused by atrial fibrillation and flutter, sinustachycardia and AV-nodal reentrant tachycardia. In two patients device discharges caused by a sensing malfunction ot the pulse generator was detected by the analysis of the stored electrogram. The new diagnostic feature of stored electrogram shows a high accuracy of rhythm classification and represents a major advance in the treatment with cardioverter/defibrillators.
29例出现药物难治性室性心律失常的患者植入了一种能够在电装置治疗前后存储心内膜电图的心脏复律除颤器。在7.5±4.6个月的随访期内，15/29例患者（51%）共经历了112次脉冲发生器放电。对104次心律失常发作时存储的心电图进行了分析。将存储心电图的形态学标准（可检测到的P波以及与窦性心律相比心动过速时QRS形态的变化）用于记录的心律失常分类。对存储心电图的分析确立了心律失常的明确诊断，并能够在每次发作时区分室上性心律失常和室性心律失常。72/104次（69.2%）放电被分类为恰当的，32/104次（30.8%）装置放电不恰当，由心房颤动和扑动、窦性心动过速以及房室结折返性心动过速引起。通过对存储心电图的分析，在两名患者中检测到由脉冲发生器感知故障导致的装置放电。存储心电图的这一新诊断特征显示出心律分类的高准确性，代表了心脏复律除颤器治疗方面的一项重大进展。
