Daoud E G, Man K C, Morady F, Strickberger S A
Department of Internal Medicine, University of Michigan Hospitals, Ann Arbor 48109-0022, USA.
Pacing Clin Electrophysiol. 1997 Mar;20(3 Pt 1):714-9. doi: 10.1111/j.1540-8159.1997.tb03890.x.
The chronic defibrillation energy requirement (DER) is believed to remain clinically stable in patients with defibrillators. Six patients (two with an epicardial and four with a nonthoracotomy system) were identified with a rise in their chronic DER, which eliminated a 10-J safety margin, thus necessitating a defibrillator lead system revision. The mean increase in DER was 14.7 +/- 4 J and was discovered at a mean of 16.0 +/- 18 months (range 2-41) following implantation. Management included placement of a defibrillator with a biphasic waveform, placement of an additional defibrillation electrode, or both. At 2 months following revision of the defibrillation system, a 10-J DER safety margin was present in each patient. In some patients, there is a progressive increase in the chronic DER with elimination of a 10-J safety margin necessitating revision of the defibrillation system. Routine reevaluation of the chronic DER, therefore, is necessary to identify these patients.
人们认为，植入除颤器的患者其慢性除颤能量需求（DER）在临床上保持稳定。已确定6例患者（2例采用心外膜系统，4例采用非开胸系统）的慢性DER升高，这消除了10焦耳的安全裕度，因此需要对除颤器导联系统进行修订。DER的平均增加量为14.7±4焦耳，在植入后平均16.0±18个月（范围2 - 41个月）时被发现。处理措施包括植入具有双相波形的除颤器、放置额外的除颤电极或两者兼用。在除颤系统修订后2个月时，每位患者均有10焦耳的DER安全裕度。在一些患者中，慢性DER会逐渐增加，消除了10焦耳的安全裕度，因此需要修订除颤系统。因此，对慢性DER进行常规重新评估对于识别这些患者是必要的。
