Lerman R D, Cannom D S
Good Samaritan Hospital, Los Angeles, CA 90017-2395, USA.
Curr Opin Cardiol. 1996 Jan;11(1):16-22. doi: 10.1097/00001573-199601000-00004.
Significant advances in the basic science of implantable cardioverter-defibrillator therapy have led to improvements in defibrillation waveforms and in capacitor technology. Nonthoracotomy devices with biphasic waveforms can be implanted with a near 100% success rate. Although fewer patients with implantable cardioverter-defibrillators are being treated with concomitant antiarrhythmic drug therapy, sotalol appears to decrease the defibrillation threshold. Controversy still exists over the optimal design for defibrillator sensing leads. Tachyarrhythmia detection enhancement increase specificity for sensing ventricular tachycardia but may risk undersensing. A variety of subsets of patients receiving implantable cardioverter-defibrillators have been identified; patients presenting with ventricular fibrillation appear to have the most unfavorable prognosis. Controversy exists as to the true impact of implantable cardioverter-defibrillator therapy on subsequent survival. Randomized clinical trials such as AVID (Antiarrhythmics Versus Implantable Defibrillators) are designed to determine the true benefits of implantable cardioverter-defibrillators and may lead to expanded indications.
植入式心脏复律除颤器治疗的基础科学取得了重大进展，这带来了除颤波形和电容器技术的改进。具有双相波形的非开胸装置植入成功率接近100%。虽然接受植入式心脏复律除颤器治疗的患者中，同时接受抗心律失常药物治疗的人数减少，但索他洛尔似乎能降低除颤阈值。关于除颤器感知导线的最佳设计仍存在争议。快速心律失常检测增强提高了感知室性心动过速的特异性，但可能存在感知不足的风险。已确定接受植入式心脏复律除颤器治疗的多种患者亚组；出现心室颤动的患者预后似乎最不利。关于植入式心脏复律除颤器治疗对后续生存的真正影响存在争议。诸如AVID（抗心律失常药物与植入式除颤器）等随机临床试验旨在确定植入式心脏复律除颤器的真正益处，并可能导致适应证的扩大。
