Clinical efficacy of a wearable defibrillator in acutely terminating episodes of ventricular fibrillation using biphasic shocks
Clinical efficacy of a wearable defibrillator in acutely terminating episodes of ventricular fibrillation using biphasic shocks
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DOI：
10.1046/j.1460-9592.2003.00311.x
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发表时间：
2003-10-01
影响因子：
1.8
通讯作者：
Klein, HU
中科院分区：
文献类型：
--
作者：
Reek, S;Geller, JC;Klein, HU
可穿戴式心脏复律除颤器(WCD)可自动检测和治疗室性心律失常，无需旁观者的帮助，同时允许患者自由走动。对于有暂时性心源性猝死风险的门诊人群来说，它代表着紧急医疗服务的替代方案。虽然最初的设备使用单相截断指数波形来进行复律/除颤电击，但为下一代设备开发了一种新的双相电击。在12名接受室性快速性心律失常电生理测试的患者中，尝试通过WCD终止电诱导性室颤(VF)。在22个事件中，诱发室颤被前70J(n=12)或100J(n=10)双相电击迅速终止。心律失常发生至休克时间分别为22±6秒(70 J)和21±6秒(100 J)(P=NS)。经胸测得的阻抗为71+/-5欧姆(-79欧姆)和+/-8欧姆(47-72欧姆)(100J冲击)。本研究表明，WCD发出的单个低能量双相电击可以可靠地终止电诱发的室性心动过速(100%的发作)。这项研究的结果表明，对于该装置的最大输出(150J)，存在可接受的安全裕度。尽管我们的数据前景看好，但我们建议在门诊患者使用WCD时，应对所有电击进行编程，以获得最大的能量输出。
The Wearable Cardioverter Defibrillator (WCD) automatically detects and treats ventricular tachyarrhythmias without the need for assistance from a bystander, while at the same time allowing,the patient to ambulate freely. It represents an alternative to emergency medical services for outpatient populations with a temporary risk of sudden cardiac death. While the original devices used a monophasic truncated exponential waveform for cardioversion/defibrillation shocks, a new, biphasic shock was developed for the next device generation. In 12 patients undergoing electrophysiological testing for ventricular tachyarrhythmias, termination of electrically induced ventricular fibrillation (VF) was attempted via the WCD. In 22 episodes, induced VF was promptly terminated by the first 70 J (n = 12) or 100 J (n = 10) biphasic shocks. Time between arrhythmia initiation and shock delivery was 22 +/- 6 seconds (70 J) and 21 +/- 6 seconds (100 J) (P = NS). The measured transthoracic impedance was 71 +/- 5 Ohm (64-79 Ohm) for the 70 J shock and 64 +/- 8 Ohm (47-72 Ohm) for the 100 J shock. The present study demonstrates that a single low energy biphasic shock delivered by the WCD, reliably terminates electrically induced VF (100% of episodes). The results of this study suggest that there is an acceptable safety margin to the maximum output of the device (150 J). Despite our promising data, we recommend that programming all shocks for maximum energy output should be done when using the WCD in ambulatory patients.