Weiss D N, Zilo P, Luceri R M, Platt S, Rosenbaum M
Florida Arrhythmia Consultants, Fort Lauderdale, USA.
Am J Cardiol. 1997 Dec 15;80(12):1562-5. doi: 10.1016/s0002-9149(97)00748-0.
Complete postoperative evaluation of implantable cardioverter-defibrillators (ICDs) before discharge, including arrhythmia induction, has been the standard since their introduction. Whereas the original ICDs provided little telemetered information and used separate pace-sense and defibrillation leads, modern, third-generation devices provide pace-sense function information in addition to other data and are used in conjunction with integrated transvenous endocardial leads that combine pace-sense and defibrillation function. Changes in lead position, which can potentially result in either an inability to detect fibrillation or to terminate it, should be mirrored by changes in resting pace-sense function. Thus, for newer ICDs implanted with integrated endocardial lead systems, it is possible that in at least some cases predischarge arrhythmia inductions can be avoided. Two hundred patients receiving third-generation ICDs in conjunction with integrated transvenous leads were evaluated before discharge. Defibrillation detection or termination problems were seen in 8. Declines in resting R-wave amplitude and pacing impedance were significantly associated with such complications (-7 +/- 5 vs -0.3 +/- 2.3 mV [p <0.0001] and -158 +/- 138 vs -93 +/- 76 omega [p <0.05], for those with vs without complications, respectively), as were gross right ventricular lead migrations on chest x-ray. No patient with a defibrillation complication had an R-wave change of <3 mV. However, 13% of patients without complications had R-wave changes of >3 mV. It is concluded that a pace-sense evaluation of ICDs may be a satisfactory screen to determine those who need to go on to complete testing with arrhythmia induction in selected cases.
自植入式心脏复律除颤器（ICD）问世以来，出院前对其进行全面的术后评估，包括心律失常诱发试验，一直是标准做法。早期的ICD提供的遥测信息很少，且起搏感知和除颤电极是分开的，而现代第三代设备除了其他数据外，还能提供起搏感知功能信息，并与集成了起搏感知和除颤功能的经静脉心内膜电极配合使用。电极位置的改变可能导致无法检测到颤动或无法终止颤动，这应反映在静息起搏感知功能的变化上。因此，对于植入了集成心内膜电极系统的新型ICD，至少在某些情况下，有可能避免出院前的心律失常诱发试验。对200例接受第三代ICD并植入集成经静脉电极的患者在出院前进行了评估。发现有8例存在除颤检测或终止问题。静息R波振幅和起搏阻抗的下降与这些并发症显著相关（有并发症者为-7±5 mV，无并发症者为-0.3±2.3 mV [p<0.0001]；有并发症者为-158±138 Ω，无并发症者为-93±76 Ω [p<0.05]），胸部X线显示的右心室电极明显移位也与之相关。没有发生除颤并发症的患者R波变化均<3 mV。然而，13%没有并发症的患者R波变化>3 mV。结论是，对ICD进行起搏感知评估可能是一种令人满意的筛选方法，可确定在某些特定情况下需要进行完整心律失常诱发试验的患者。
