Osswald S, Candinas R, Fuhrer J
Elektrophysiologische Laboratorien, Kardiologischen Abteilungen, Universitätskliniken, Basel.
Schweiz Med Wochenschr. 1995 Dec 16;125(50):2423-32.
The most important technical improvements of implantable cardioverter-defibrillators (ICD) of the latest generation comprise more sophisticated antitachycardia pacing options, stored intracardiac electrograms and biphasic shock capabilities which virtually always allow ICD implantation without thoracotomy. The present study summarizes the first clinical experience with these new devices. In 37 consecutive symptomatic (near sudden death 17, syncope 16, pre-syncope 4) patients aged 56 +/- 10 years with refractory ventricular arrhythmias (presenting arrhythmia: ventricular fibrillation 14, ventricular tachycardia 22, not documented 1), an ICD (Jewel PCD 7219, Medtronic) was implanted. Coronary artery disease was present in 21, dilated cardiomyopathy in 5, valvular heart disease in 2 and various conditions in 8 patients; the mean left ventricular ejection fraction was 43 +/- 18%. In 29 patients (78%), the ICD was inserted in a pectoral and in 8 (22%) in an abdominal position. A non-thoracotomy lead (NTL) configuration was successfully implanted in 36/37 patients (97%) (purely transvenous systems in 30, in combination with subcutaneous patch electrode in 6). Surgical complications comprised one pneumothorax, one hemorrhage and one death due to sepsis; during a mean follow-up of 5 +/- 3 months, another patient died of heart failure and 2 revisions (5.4%) for lead problems (1 connector, 1 SQ-patch) became necessary. In 23/37 patients (62%), the ICD was activated after 74 +/- 89 days post implant. 22 of these 23 patients (96%) received one or more appropriate shocks (9 +/- 22 shocks per patient). The actuarial survival was 95% at 6 months. In the present study, an ICD of the newest generation was successfully implanted without thoracotomy in > or = 97% and with purely transvenous systems in > or = 84%. Compared to older systems, this has made the implantation procedure remarkably easier and will most likely lead to a further reduction in mortality and morbidity. Despite the relatively short follow-up, the high incidence of appropriate ICD utilization underscores the high recurrence rate of arrhythmias in this population and suggests that the ICD may be very effective in preventing unnecessary rehospitalizations.
最新一代植入式心脏复律除颤器（ICD）最重要的技术改进包括更复杂的抗心动过速起搏选项、心内电图存储以及双相电击功能，这些改进几乎总能使ICD无需开胸植入。本研究总结了使用这些新设备的首批临床经验。在37例连续的有症状患者（17例接近猝死，16例晕厥，4例先兆晕厥）中，年龄为56±10岁，患有难治性室性心律失常（表现出的心律失常：14例心室颤动，22例室性心动过速，1例未记录），植入了一台ICD（美敦力公司的Jewel PCD 7219）。21例患者存在冠状动脉疾病，5例为扩张型心肌病，2例为瓣膜性心脏病，8例为其他各种情况；平均左心室射血分数为43±18%。29例患者（78%）的ICD植入于胸部，8例（22%）植入于腹部。36/37例患者（97%）成功植入了非开胸导联（NTL）配置（30例为单纯经静脉系统，6例为与皮下贴片电极联合使用）。手术并发症包括1例气胸、1例出血和1例因败血症死亡；在平均5±3个月的随访期间，另1例患者死于心力衰竭，2例（5.4%）因导联问题（1个连接器，1个皮下贴片）需要进行修订。23/37例患者（62%）在植入后74±89天激活了ICD。这23例患者中有22例（96%）接受了一次或多次适当电击（每位患者9±22次电击）。6个月时的精算生存率为95%。在本研究中，≥97%的患者成功通过非开胸方式植入了最新一代ICD，≥84%的患者采用了单纯经静脉系统。与旧系统相比，这使得植入过程明显更容易，很可能会进一步降低死亡率和发病率。尽管随访时间相对较短，但ICD适当使用率较高突出了该人群心律失常的高复发率，并表明ICD在预防不必要的再次住院方面可能非常有效。
