Geiger M J, O'Neill P, Sharma A, Skadsen A, Zimerman L, Greenfield R A, Newby K H, Wharton J M, Kent V, Natale A
Department of Cardiology, Duke University Medical Center, Durham, North Carolina, USA.
Pacing Clin Electrophysiol. 1997 Mar;20(3 Pt 1):624-30. doi: 10.1111/j.1540-8159.1997.tb03880.x.
Limited information is available regarding potential adverse interactions between transvenous nonthoracotomy cardioverter defibrillators and pacemakers. We describe our experience with 37 patients who have undergone successful implantation of both a transvenous defibrillator and pacemaker. The patients' mean age was 64 +/- 12.9 years. Thirty-three were male and four were female. The mean LVEF was 30.8% +/- 11.8%. The indications for pacemaker implantation included sick sinus syndrome in 13 patients, complete heart block in 15 patients, sinus bradycardia secondary to medications in 8 patients, and neurocardiogenic syncope in 1 patient. The indications for insertion of a defibrillator included medically refractory VT in 27 patients and sudden cardiac death in 10 patients. Twenty-three patients received an Endotak lead and 14 patients received a Transvene lead. Eighteen patients had a pacemaker prior to an ICD, 14 patients had an ICD prior to a pacemaker, and 4 patients had both devices placed simultaneously. Interaction was evaluated at implant of the second device and 1-3 days after both devices were placed. Detection of VF/VT was analyzed during asynchronous pacing (DOO/VOO) with maximum pacing output. In addition, in six patients, DFT was determined before and after pacemaker implantation. In 14 patients (38%), device interactions that could not always be optimally corrected were observed. In five patients, the pacemaker was reset to the "noise reversion" mode after high energy ICD discharge. Oversensing of atrial pacemaker stimuli resulted in inappropriate ICD firings in four patients. This was observed only with a specific device and could not be prevented by atrial lead repositioning in two of them, but required reprogramming of the pacemaker to the VVI mode. An increase in DFT was observed in five patients who had a pacemaker implanted after an ICD. Compared with previously published studies, a greater frequency of transvenous ICD and pacemaker interactions were observed. Considering that almost 50% of the patients already have a pacemaker at the time of ICD implant, the availability of defibrillators with dual chamber pacing capability will not eliminate the potential for this problem.
关于经静脉非开胸心脏复律除颤器与起搏器之间潜在的不良相互作用，目前可用信息有限。我们描述了37例成功植入经静脉除颤器和起搏器患者的经验。患者的平均年龄为64±12.9岁。33例为男性，4例为女性。平均左心室射血分数为30.8%±11.8%。植入起搏器的指征包括13例病态窦房结综合征、15例完全性心脏传导阻滞、8例药物引起的窦性心动过缓以及1例神经心源性晕厥。植入除颤器的指征包括27例药物难治性室性心动过速和10例心脏性猝死。23例患者接受了Endotak导线，14例患者接受了Transvene导线。18例患者在植入植入式心律转复除颤器（ICD）之前已有起搏器，14例患者在植入起搏器之前已有ICD，4例患者同时植入了这两种装置。在植入第二个装置时以及植入两个装置后1 - 3天对相互作用进行评估。在最大起搏输出的非同步起搏（DOO/VOO）期间分析室颤/室性心动过速的检测情况。此外，在6例患者中，在植入起搏器前后测定了除颤阈值（DFT）。在14例患者（38%）中观察到了并非总能得到最佳纠正的装置相互作用。在5例患者中，高能ICD放电后起搏器被重置为“噪声反转”模式。4例患者出现心房起搏器刺激的过度感知导致不适当的ICD放电。仅在特定装置中观察到这种情况，其中2例患者通过重新定位心房导线无法预防，而是需要将起搏器重新编程为VVI模式。在ICD植入后植入起搏器的5例患者中观察到DFT增加。与先前发表的研究相比，观察到经静脉ICD与起搏器相互作用的频率更高。考虑到几乎50%的患者在植入ICD时已经有起搏器，具备双腔起搏功能的除颤器的可用性并不能消除这个问题的可能性。
