Callans D J, Swarna U S, Schwartzman D, Gottlieb C D, Marchlinski F E
Clinical Electrophysiology Laboratory, Philadelphia Heart Institute, Presbyterian Medical Center, Pennsylvania 19104, USA.
J Cardiovasc Electrophysiol. 1995 Aug;6(8):604-12. doi: 10.1111/j.1540-8167.1995.tb00436.x.
The sensing performance of transvenous lead systems may be adversely affected by the delivery of high-energy shocks. This may be due to the proximity of the sensing and energy-delivery electrodes on transvenous leads.
The time required for detection of ventricular fibrillation and redetection after a failed first shock was compared in 93 patients with five different lead system-pulse generator combinations: Cadence--Endotak 60 series, Ventak P--Endotak 60 series, Jewel--Transvene, Cadence--TVL, and Cadence--Transvene. A total of 418 successful and 204 failed first shocks were delivered during induced ventricular fibrillation. Redetection times (RED) were consistently shorter than detection times (DET) in the Jewel-Transvene (RED minus DET: -1.9 +/- 0.8 sec, P < 0.0001), the Cadence-TVL (-1.6 +/- 1.0 sec, P < 0.0001), and the Cadence-Transvene combinations (-2.0 +/- 0.9 sec, P < 0.0004). Redetection times were not significantly different than detection times in the Cadence-Endotak combination (0.9 +/- 3.1 sec; P = 0.09). Redetection times were significantly longer than detection times in the Ventak-Endotak combination (1.2 +/- 2.3 sec; P = 0.034). Prolonged individual redetection episodes (> 8.2 sec) were observed in the Cadence-Endotak (7 [10%] of 73 episodes) and the Ventak-Endotak (4 [10%] of 39 episodes), but not in the Jewel-Transvene, the Cadence-TVL, and the Cadence-Transvene combinations.
Redetection of ventricular fibrillation may be delayed in some transvenous lead-pulse generator combinations. Successful redetection of ventricular fibrillation following a failed first shock should be demonstrated prior to hospital discharge of patients with implantable defibrillators.
经静脉导线系统的传感性能可能会受到高能量电击的不利影响。这可能是由于经静脉导线上传感电极和能量输送电极距离较近所致。
对93例患者使用五种不同的导线系统 - 脉冲发生器组合（Cadence - Endotak 60系列、Ventak P - Endotak 60系列、Jewel - Transvene、Cadence - TVL和Cadence - Transvene），比较检测室颤所需时间以及首次电击失败后重新检测的时间。在诱发室颤期间共进行了418次成功的首次电击和204次失败的首次电击。在Jewel - Transvene组合（重新检测时间减去检测时间：-1.9±0.8秒，P < 0.0001）、Cadence - TVL组合（-1.6±1.0秒，P < 0.0001）和Cadence - Transvene组合（-2.0±0.9秒，P < 0.0004）中，重新检测时间始终短于检测时间。在Cadence - Endotak组合中，重新检测时间与检测时间无显著差异（0.9±3.1秒；P = 0.09）。在Ventak - Endotak组合中，重新检测时间显著长于检测时间（1.2±2.3秒；P = 0.034）。在Cadence - Endotak组合（73次发作中的7次[10%]）和Ventak - Endotak组合（39次发作中的4次[10%]）中观察到个别重新检测时间延长（> 8.2秒），但在Jewel - Transvene、Cadence - TVL和Cadence - Transvene组合中未观察到。
在某些经静脉导线 - 脉冲发生器组合中，室颤的重新检测可能会延迟。对于植入式除颤器患者，在出院前应证明首次电击失败后能成功重新检测到室颤。
