Early experience with an implantable cardioverter.
Early experience with an implantable cardioverter.
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植入式心脏复律器的早期经验。
DOI：
10.1056/nejm198408233110801
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发表时间：
1984
期刊：
影响因子：
--
通讯作者：
Prystowsky,EN
中科院分区：
文献类型：
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作者：
Zipes,DP;Heger,JJ;Miles,WM;Mahomed,Y;Brown,JW;Spielman,SR;Prystowsky,EN
我们测试了重量为95 g的全可编程心律转复器终止持续性室性心动过速的有效性和安全性。7例患者在局部麻醉下经皮植入该装置。根据程序员的指令或自动指令，心律转复器通过插入右心室顶点的导线传送电击。它也可以作为需求心室起搏器，并可以执行程序性心室刺激或超速起搏。室性心动过速的复律需要小于0.5 J（平均），并且在清醒且未使用镇静剂的患者中耐受性良好。在一名患者中，当装置处于自动模式时，电击终止了室性心动过速，但产生了伴有快速心室反应的心房颤动，间断性地被认为是室性心动过速，引发了额外的电击。其中一例ST段休克产生心室颤动，在急诊室经胸终止，无残留损伤。我们从这些初步观察中得出结论，通过植入式导管装置对持续性室性心动过速的复心是可行的，但目前在自动模式下使用必须谨慎和有选择性。该装置体积小，易于植入，可用于无创电生理研究，可编程性和心动过缓起搏功能是其优点。下一代设备必须能够除颤并提供更好的心律失常鉴别。[中华医学杂志1984；31:485 - 90]
We tested the efficacy and safety of a fully programmable cardioverter weighing 95 g, in terminating sustained ventricular tachycardia. The device was implanted transvenously under local anesthesia in seven patients. On command from a programmer or automatically, the cardioverter delivered shocks through a lead inserted to the apex of the right ventricle. It also served as a demand ventricular pacemaker and could perform programmed ventricular stimulation or overdrive pacing. Cardioversion of ventricular tachycardia required less than 0.5 J (mean) and was well tolerated by the patients, who were awake and not sedated. In one patient, a shock terminated ventricular tachycardia with the device in the automatic mode but produced atrial fibrillation with a rapid ventricular response that was intermittently recognized as ventricular tachycardia, triggering additional shocks. One such shock in the ST segment produced ventricular fibrillation that was terminated transthoracically in the emergency room, without residual impairment.We conclude from these preliminary observations that cardioversion of sustained ventricular tachycardia by means of an implantable catheter device is feasible, but for the present its use in the automatic mode must be cautious and selective. The unit's small size, ease of implantation, usefulness for noninvasive electrophysiologic studies, programmability, and bradycardia pacing functions are advantages. The next-generation device must be able to defibrillate and provide better differentiation of arrhythmias. (N Engl J Med 1984; 311:485–90.)