Goldberger J J, Horvath G, Donovan D, Johnson D, Challapalli R, Kadish A H
Department of Medicine, and Feinberg Cardiovascular Research Institute, Northwestern University, Chicago, Illinois, USA.
J Cardiovasc Electrophysiol. 1998 Jul;9(7):677-88. doi: 10.1111/j.1540-8167.1998.tb00954.x.
Dedicated bipolar sensing has been suggested to be safer than integrated bipolar sensing due to an increased incidence of failure to redetect ventricular fibrillation after an unsuccessful shock with leads that use integrated bipolar sensing. We compared sensing characteristics during ventricular fibrillation of simultaneously recorded dedicated and integrated bipolar electrograms.
Thirty patients undergoing transvenous defibrillator implantation with a Transvene lead were studied. Simultaneous recordings were made from the dedicated bipole and the integrated bipole from the distal tip to the coil (interelectrode distance 18.3 mm). The mean detection time and number of undetected beats for the initial episode of ventricular fibrillation were 2804 +/- 569 msec and 0.9 +/- 0.8 using the dedicated recordings and 2938 +/- 546 msec and 1.4 +/- 1.1 (P = 0.026) using the integrated recordings. The mean redetection times and number of undetected beats following a failed first shock (n = 13) were 2468 +/- 225 msec and 0.8 +/- 1.1 for the dedicated recordings and 3042 +/- 498 msec (P < 0.0003) and 4.2 +/- 4.2 (P < 0.005) for the integrated recordings. Frequency analysis of the ventricular fibrillation electrograms demonstrated that the signal energy in the dedicated electrograms was significantly greater than the energy in the integrated electrograms (P < 0.0001). There was a significant negative relationship between detection times and the ventricular fibrillation signal energy. There was no independent effect of recording type (dedicated versus integrated).
There are only minor differences in detection/redetection of ventricular fibrillation between dedicated and integrated (with tip to coil spacing of 18.3 mm) recording configurations. Detection times during ventricular fibrillation are related to the signal variance or energy recorded. Differences in the sensing performance of the two recording configurations can be explained by the differences in signal energy between the dedicated and integrated recordings that occur during ventricular fibrillation.
有研究表明，专用双极感知比集成双极感知更安全，因为使用集成双极感知的导联在电击失败后重新检测到室颤的发生率增加。我们比较了同时记录的专用和集成双极心电图在室颤期间的感知特性。
对30例接受经静脉除颤器植入术并使用Transvene导联的患者进行了研究。从专用双极电极和从远端尖端到线圈的集成双极电极（电极间距18.3毫米）同时进行记录。室颤初始发作时，使用专用记录的平均检测时间和未检测到的搏动次数分别为2804±569毫秒和0.9±0.8，使用集成记录的分别为2938±546毫秒和1.4±1.1（P = 0.026）。首次电击失败后（n = 13），专用记录的平均重新检测时间和未检测到的搏动次数分别为2468±225毫秒和0.8±1.1，集成记录的分别为3042±498毫秒（P < 0.0003）和4.2±4.2（P < 0.005）。室颤心电图的频率分析表明，专用心电图中的信号能量明显大于集成心电图中的能量（P < 0.0001）。检测时间与室颤信号能量之间存在显著的负相关关系。记录类型（专用与集成）没有独立影响。
专用和集成（尖端到线圈间距为18.3毫米）记录配置在室颤检测/重新检测方面只有微小差异。室颤期间的检测时间与记录的信号方差或能量有关。两种记录配置在感知性能上的差异可以通过室颤期间专用记录和集成记录之间信号能量的差异来解释。
