Korte T, Jung W, Spehl S, Wolpert C, Moosdorf R, Manz M, Lüderitz B
Department of Cardiology, University of Bonn, Germany.
Pacing Clin Electrophysiol. 1995 Nov;18(11):2053-61. doi: 10.1111/j.1540-8159.1995.tb03867.x.
The aim of this study was to evaluate the long-term stability of epicardial and endocardial lead systems for third-generation cardioverter defibrillators (ICDs) and to assess the usefulness of diagnostic tools. One hundred forty patients with 61 epicardial (43.6%) and 79 nonthoracotomy systems (56.4%) were followed for 25 +/- 19 months. A total of 18 (12.9%) lead related complications were documented. Complications of epicardial systems were detected in 10 patients (16.4%) during a follow-up time of 36 +/- 8 months: crinkling of patch electrodes in 6 patients (9.8%), insulation breakage of sensing electrodes in 2 patients (3.3%), and adapter defect in 2 patients (3.3%). Eight of the patients (10.1%) with transvenous-subcutaneous systems had lead related complications during a 13 +/- 6 months follow-up: fracture of the subcutaneous patch lead in 2 patients (2.5%), dislodgement of the right ventricular lead in 2 patients (2.5%), dislodgement of the superior vena cava lead in 2 patients (2.5%), insulation breakage of sensing electrodes in 1 patient (1.3%), and connector defect in 1 patient (1.3%). There was no significant difference in the incidence of lead related complications between epicardial and endocardial systems (P > 0.05). Fractures, dislodgements, and crinklings were documented within the first 8 +/- 5 months by regular chest X ray. Defects of insulation, adapter, or connector were detected 22 +/- 10 months after implantation and were associated with delivery of multiple inappropriate ICD therapies. An operative lead revision was indicated for 4 epicardial (6.6%) and 6 endocardial (7.6%) lead systems.
Endocardial lead systems offer a similar long-term stability as compared to epicardial lead systems. Chest X ray is the most useful tool to detect lead fracture, dislodgment, and patch crinkling. Marker recordings or real-time electrograms have not been helpful in this series to identify patients with suspected lead defects prior to the experience of inappropriate ICD discharges.
本研究旨在评估第三代心脏复律除颤器（ICD）的心外膜和心内膜导联系统的长期稳定性，并评估诊断工具的实用性。140例患者，其中61例采用心外膜导联系统（43.6%），79例采用非开胸导联系统（56.4%），随访时间为25±19个月。共记录到18例（12.9%）与导联相关的并发症。在心外膜导联系统患者中，随访36±8个月期间有10例（16.4%）出现并发症：6例（9.8%）片状电极起皱，2例（3.3%）感知电极绝缘破损，2例（3.3%）转接器缺陷。8例（10.1%）经静脉-皮下导联系统患者在13±6个月的随访期间出现与导联相关的并发症：2例（2.5%）皮下片状导联断裂，2例（2.5%）右心室导联脱位，2例（2.5%）上腔静脉导联脱位，1例（1.3%）感知电极绝缘破损，1例（1.3%）连接器缺陷。心外膜和心内膜导联系统与导联相关并发症的发生率无显著差异（P>0.05）。骨折、脱位和起皱在最初8±5个月内通过定期胸部X线检查记录。绝缘、转接器或连接器缺陷在植入后22±10个月被检测到，并与多次不适当的ICD治疗有关。4例（6.6%）心外膜导联系统和6例（7.6%）心内膜导联系统需要进行手术导联修正。
与心外膜导联系统相比，心内膜导联系统具有相似的长期稳定性。胸部X线检查是检测导联骨折、脱位和片状电极起皱最有用的工具。在本系列研究中，在出现不适当的ICD放电之前，标记记录或实时心电图对于识别疑似导联缺陷的患者并无帮助。
