Sadoul N, Blankoff I, de Chillou C, Beurrier D, Messier M, Bizeau O, Magnin I, Dodinot B, Aliot E
Service de Cardiologie, CHU de Nancy, France.
J Interv Card Electrophysiol. 1997 Nov;1(3):227-33. doi: 10.1023/a:1009721023732.
The objective of this study was to assess the effects of radiofrequency energy application on implanted pacemaker functions. Radiofrequency (RF) catheter ablation may cause pacemaker dysfunction due to electromagnetic interferences. The effects of RF on pacemaker behavior were studied in a series of 38 pacemakers, implanted 18 +/- 26 months prior to a RF procedure using either a right ventricular approach (AV node ablation, n = 35) or a left ventricular approach (left concealed accessory pathway ablation, n = 1; VT ablation, n = 2). The 38 patients (mean age 65 +/- 9 years) included 20 men and 18 women. Before energy applications, the 23 different pacemaker models were programmed to the VVI mode at the lowest available rate. The continuous surface ECG was recorded throughout the procedure. Thorough testing of the devices was performed before and after each RF delivery. Unusual pacemaker responses occurred in 20 of the 38 cases studied (53%). The impact of RF delivery was unpredictable, and variable dysfunctions were observed at different times for a given patient or could vary for a given model. Unusual pacemaker responses included pacemaker inhibition (n = 8), untoggled backup mode (n = 3), electromagnetic interference noise mode (n = 3), temporary RF-induced pacemaker tachycardia (n = 2), erratic behavior (n = 1), oversensing of RF onset and offset (n = 8), and transient loss of ventricular capture, (n = 1). Postablation, most devices automatically toggled back to full functionality. The three devices in the untoggled backup mode had to be reprogrammed to obtain normal operations. At the end of the procedure, pacing thresholds remained unchanged in all but one patient, in whom the increase in ventricular threshold was due to a nicked lead. In conclusion, implanted pacemakers frequently exhibit transient, unpredictable responses to RF energy application. Although all pacemaker functions were restored postablation, some devices had to be reset manually. The anomalies observed during the RF application argue for the simultaneous use of an external pacemaker in pacing-dependent patients.
本研究的目的是评估射频能量应用对植入式起搏器功能的影响。射频（RF）导管消融可能由于电磁干扰而导致起搏器功能障碍。在一系列38台起搏器中研究了RF对起搏器行为的影响，这些起搏器在进行RF手术前18±26个月植入，采用右心室途径（房室结消融，n = 35）或左心室途径（左侧隐匿性旁路消融，n = 1；室性心动过速消融，n = 2）。38例患者（平均年龄65±9岁）包括20名男性和18名女性。在施加能量之前，将23种不同型号的起搏器以最低可用频率编程为VVI模式。在整个手术过程中记录连续的体表心电图。在每次RF释放前后对设备进行全面测试。在38例研究病例中有20例（53%）出现了异常的起搏器反应。RF释放的影响不可预测，在给定患者的不同时间观察到不同的功能障碍，或者对于给定型号可能有所不同。异常的起搏器反应包括起搏器抑制（n = 8）、未切换到备用模式（n = 3）、电磁干扰噪声模式（n = 3）、暂时性RF诱发的起搏器心动过速（n = 2）、行为不稳定（n = 1）、对RF开始和结束的过度感知（n = 8）以及心室夺获的短暂丧失（n = 1）。消融后，大多数设备自动恢复到完全功能状态。处于未切换备用模式的三台设备必须重新编程以获得正常运行。在手术结束时，除一名患者外，所有患者的起搏阈值均保持不变，该患者心室阈值升高是由于导线划伤。总之，植入式起搏器对RF能量应用经常表现出短暂、不可预测的反应。尽管消融后所有起搏器功能均恢复，但一些设备必须手动重置。在RF应用期间观察到的异常情况表明，对于起搏依赖型患者应同时使用外部起搏器。
