Zilo P, Weiss D N, Luceri R M
Florida Arrhythmia Consultants, Fort Lauderdale 33308, USA.
Pacing Clin Electrophysiol. 1999 Jan;22(1 Pt 2):197-201. doi: 10.1111/j.1540-8159.1999.tb00332.x.
One hundred five implantable cardioverter defibrillator (ICD) patients (71 +/- 9 years of age, 83% men) without spontaneous ICD discharges for > or = 12 months were tested to assess high voltage (HV) circuit integrity and the system's ability to recognize and terminate ventricular fibrillation (VF). Indications for ICD implantation were sustained ventricular tachycardia (VT) (35%), cardiac arrest (27%), and inducible VT (38%). Eighty-two percent of the patients had coronary artery disease (CAD), and the mean left ventricular ejection fraction (LVEF) was 36% +/- 13%.
One hundred patients had inducible VF and five did not. Testing led to ICD reprogramming in 50 (49%) patients. Two (1.9%) patients required ICD replacement: (1) a 45-year-old patient with a Ventritex 110 ICD implanted for 13 months interfaced with a CPI 0062 lead implanted for 46 months could not be defibrillated internally (impedance nonmeasurable); (2) an 82-year-old patient with a 23-month-old Medtronic 7219 ICD interfaced with 6936 and 6933 leads whose defibrillation threshold (DFT) had doubled since implantation (24 J from 12 J). Lead fractures were found in both cases (proximal coil of the 0062, and subcutaneously in the 6933). Based on DFT determinations, the first shock output was programmed lower in 37 patients and higher in 10 patients. Shock pulse width was changed in one patient and the ventricular refractory period in another. No programming changes were made in 54 (51%) patients.
(1) Late testing of HV circuit integrity in ICD patients without an ICD shock in > or = 12 months identifies previously unsuspected HV lead fractures; (2) chronic DFT testing resulted in HV output reprogramming in one-half of the patients.
对105例植入式心脏复律除颤器（ICD）患者（年龄71±9岁，83%为男性）进行了测试，这些患者至少12个月内未发生过ICD自发放电，以评估高压（HV）电路完整性以及系统识别和终止心室颤动（VF）的能力。ICD植入的适应证为持续性室性心动过速（VT）（35%）、心脏骤停（27%）和可诱导的VT（38%）。82%的患者患有冠状动脉疾病（CAD），平均左心室射血分数（LVEF）为36%±13%。
100例患者可诱导出VF，5例患者不能。测试导致50例（49%）患者的ICD重新编程。2例（1.9%）患者需要更换ICD：（1）一名45岁患者，植入Ventritex 110 ICD 13个月，连接植入46个月的CPI 0062导线，无法进行体内除颤（阻抗无法测量）；（2）一名82岁患者，植入23个月的美敦力7219 ICD，连接6936和6933导线，自植入以来除颤阈值（DFT）增加了一倍（从12 J增至24 J）。两例均发现导线断裂（0062的近端线圈，6933导线位于皮下）。根据DFT测定结果，37例患者首次电击输出被编程降低，10例患者被编程提高。1例患者的电击脉冲宽度发生改变，另1例患者的心室不应期发生改变。54例（51%）患者未进行编程更改。
（1）对至少12个月内未发生ICD电击的ICD患者进行HV电路完整性的后期测试可发现先前未被怀疑的HV导线断裂；（2）慢性DFT测试导致一半患者的HV输出重新编程。
