Golino A, Pappone C, Panza A, Santomauro M, Iorio D, De Amicis V, Chiariello M, Spampinato N
Department of Cardiology and Cardiac Surgery, II Medical School, Federico II University of Naples, Italy.
Tex Heart Inst J. 1993;20(4):264-70.
We review our experience with the transvenous Medtronic Pacer Cardioverter Defibrillator System (Model 7217B), a multifunction implantable pacer defibrillator combined with a transvenous lead system (Transvene). From April 1991 to October 1992, we implanted this device in 19 consecutive patients (11 men and 8 women; average age, 56.5 years). Nine patients (47.4%), 5 with coronary artery disease and 4 with dilated cardiomyopathy, had an ejection fraction of < 30%. The average operative time was 129 minutes. In 18 patients (94.7%), the transvenous lead system provided effective sensing, pacing, and defibrillation during intraoperative testing. In each of these cases, the defibrillation threshold was less than 18 J. In 1 patient (5.3%), it was necessary to switch to epicardial leads, which were implanted through a left thoracotomy. All patients were extubated in the recovery room. The average hospital stay was 8 days. There was no early mortality or morbidity. During a maximum follow-up period of 17 months (mean, 9.2 months), no sudden death occurred. The implantable system terminated 245 ventricular tachycardia episodes in 14 patients (73.7%) and 82 ventricular fibrillation episodes in 13 patients (68.4%). Two hundred eleven (86.1%) of the ventricular tachycardia episodes were resolved by antitachycardia pacing alone. In 2 patients (10.5%), the caval electrode became dislocated; repositioning of the electrode was followed by repeat defibrillation threshold evaluation. Our experience shows that the transvenous Medtronic Pacer Cardioverter Defibrillator System provides safe, effective treatment of ventricular tachyarrhythmias. Because the perioperative mortality and morbidity are extremely low, use of this device may be particularly beneficial in patients with a high operative risk. Moreover, the lower number of unpleasant therapeutic shocks should increase patient a acceptance of the device.
我们回顾了使用美敦力经静脉起搏器除颤器系统（7217B型号）的经验，这是一种多功能植入式起搏器除颤器，结合了经静脉导线系统（Transvene）。从1991年4月至1992年10月，我们连续为19例患者（11名男性和8名女性；平均年龄56.5岁）植入了该设备。9例患者（47.4%），5例患有冠状动脉疾病，4例患有扩张型心肌病，射血分数<30%。平均手术时间为129分钟。18例患者（94.7%）中，经静脉导线系统在术中测试期间提供了有效的感知、起搏和除颤功能。在这些病例中，除颤阈值均低于18焦耳。1例患者（5.3%）需要改用经左胸切口植入的心外膜导线。所有患者均在恢复室拔管。平均住院时间为8天。无早期死亡或发病情况。在最长17个月（平均9.2个月）的随访期内，未发生猝死。植入式系统终止了14例患者（73.7%）的245次室性心动过速发作和13例患者（68.4%）的82次心室颤动发作。211次（86.1%）室性心动过速发作仅通过抗心动过速起搏得以解决。2例患者（10.5%）的腔静脉电极发生脱位；电极重新定位后进行了重复除颤阈值评估。我们的经验表明，美敦力经静脉起搏器除颤器系统为室性快速心律失常提供了安全、有效的治疗。由于围手术期死亡率和发病率极低，该设备的使用可能对手术风险高的患者特别有益。此外，较少的不愉快治疗电击次数应会增加患者对该设备的接受度。
