Winter J, Heil J E, Schumann C, Lin Y, Schannwell C M, Michel U, Schipke J D, Schulte H D, Gams E
Department of Thoracic and Cardiovascular Surgery, Heinrich-Heine-University, Duesseldorf, Germany.
Eur J Cardiothorac Surg. 1998 Oct;14(4):419-25. doi: 10.1016/s1010-7940(98)00215-2.
The effect of implantable cardioverter/defibrillator (ICD) lead placement in the right ventricle (RV) on defibrillation efficacy has not been thoroughly investigated. Therefore, the goal of this combined experimental and clinical study was to evaluate the effect of a septal and a non-septal position of the right ventricular endocardial spring lead on defibrillation energy.
In 12 isoflurane-anaesthetized swine and subsequently in 8 patients who underwent ICD implantation, two different positions of the distal spring lead in the RV were investigated in randomized order: non-septal position (free wall of the RV) and septal position (interventricular septum). For each position, separate 50% probability determinations of energy (E50), peak voltage (V50) and peak current (A50) were calculated using the three reversal up/down defibrillation procedure. The E50, V50, A50 and impedance (I) were averaged and compared using the two-sided t-test for paired samples.
Both the experimental study and the clinical study demonstrated that placing the distal defibrillation lead near to the septum rather than near to the ventricular free wall resulted both in the swine and in the patients in significantly lower E50-31.6%/ - 37.1%, V50-16.1%/-20.9% and A50 -10.0%/ - 24.2%, respectively. Defibrillation impedances were significantly reduced only in the experimental study.
Defibrillation efficacy depends on the position of the distal spring electrode in the RV. A septal position significantly reduces the energy requirements compared to a non-septal position. The decrease in energy requirements might be explained by an increase in current flow through the septum and the posterolateral wall of the left ventricle. reserved
植入式心脏复律除颤器（ICD）导线置于右心室（RV）对除颤效果的影响尚未得到充分研究。因此，本项实验与临床相结合的研究目的是评估右心室心内膜弹簧导线的间隔和非间隔位置对除颤能量的影响。
对12只异氟烷麻醉的猪，随后对8例接受ICD植入的患者，以随机顺序研究右心室远端弹簧导线的两个不同位置：非间隔位置（右心室游离壁）和间隔位置（室间隔）。对于每个位置，使用三次反向向上/向下除颤程序分别计算能量（E50）、峰值电压（V50）和峰值电流（A50）的50%概率测定值。对E50、V50、A50和阻抗（I）进行平均，并使用双侧配对样本t检验进行比较。
实验研究和临床研究均表明，将远端除颤导线置于靠近间隔而非心室游离壁的位置，在猪和患者中均导致E50分别显著降低31.6%/ - 37.1%、V50分别显著降低16.1%/ - 20.9%、A50分别显著降低10.0%/ - 24.2%。仅在实验研究中除颤阻抗显著降低。
除颤效果取决于右心室远端弹簧电极的位置。与非间隔位置相比，间隔位置可显著降低能量需求。能量需求的降低可能是由于通过室间隔和左心室后外侧壁的电流增加所致。保留
