Programming of implantable cardioverter-defibrillators on the basis of the upper limit of vulnerability.
Programming of implantable cardioverter-defibrillators on the basis of the upper limit of vulnerability.
复制标题
根据易损性上限对植入式心律转复除颤器进行编程。
DOI：
10.1161/01.cir.95.6.1497
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发表时间：
1997
期刊：
影响因子：
37.8
通讯作者：
Chen,PS
中科院分区：
文献类型：
--
作者：
Swerdlow,CD;Peter,CT;Kass,RM;Gang,ES;Mandel,WJ;Hwang,C;Martin,DJ;Chen,PS
背景一种需要最少心室颤动（VF）发作次数的患者特异性除颤有效性测量方法对于程控植入式心律转复除颤器（ICD）是有价值的。易损性上限（ULV）是最弱的电击强度，当在心动周期的易损阶段期间递送刺激时，在该最弱的电击强度处或高于该最弱的电击强度时不会诱发VF。它与除颤阈值（DFT）相关，可以通过单次VF发作来确定。本研究的目的是测试的假设，ICD编程的基础上的ULV转换自发ICD检测到的VFreliably.Methods and ResultsWe研究了100例连续患者在ICD植入和随访20±7个月。在植入时，确定ULV和DFT，并在等于ULV+3 J的电击强度下测试ICD系统。在随访期间，针对VF区检测到的心律失常，将首次电击强度程控为ULV+5 J（周期长度<292±17 ms）。我们回顾了ICD检测到的VF自发发作的存储检测间期和电描记图，以确定适当首次电击的成功率。程控首次电击强度为17.5±5.2 J。随访期间，37例患者共进行了120次适当的首次电击。心律失常为快速单形性室性心动过速（VT），占70%（31例），VF占11%（13例），多形性VT占1%，未分类的占17%（15例）。120次发作中有119次成功进行首次电击（99%; 95% CI，93%至100%）。一个未分类的事件需要两次电击。没有病人有晕厥与ICD休克或休克性死亡。ConclusionsICD休克可以编程的基础上ULV，定期节奏的测量，没有直接测量除颤的疗效。
BackgroundA patient-specific measure of defibrillation efficacy that requires a minimum number of ventricular fibrillation (VF) episodes would be valuable for programming implantable cardioverter-defibrillators (ICDs). The upper limit of vulnerability (ULV) is the weakest shock strength at or above which VF is not induced when a stimulus is delivered during the vulnerable phase of the cardiac cycle. It correlates with the defibrillation threshold (DFT) and can be determined with a single episode of VF. The objective of this study was to test the hypothesis that ICDs programmed on the basis of the ULV convert spontaneous ICD-detected VF reliably.Methods and ResultsWe studied 100 consecutive patients at ICD implantation and during follow-up of 20±7 months. At implantation, the ULV and DFT were determined, and the ICD system was tested at a shock strength equal to the ULV+3 J. During follow-up, the strength of the first shock was programmed to the ULV+5 J for arrhythmias detected in the VF zone (cycle length <292±17 ms). We reviewed stored detection intervals and electrograms from spontaneous episodes of ICD-detected VF to determine the success rate for appropriate first shocks. The programmed first-shock strength was 17.5±5.2 J. During follow-up, there were 120 appropriate first shocks in 37 patients. The arrhythmia was rapid monomorphic ventricular tachycardia (VT) in 70% of episodes (31 patients), VF in 11% (13 patients), polymorphic VT in 1%, and unclassified in 17% (15 patients). The first shock was successful in 119 of 120 episodes (99%; 95% CI, 93% to 100%). One unclassified episode required two shocks. No patient had syncope associated with an ICD shock or arrhythmic death.ConclusionsICD shocks can be programmed on the basis of the ULV, a measurement made in regular rhythm, without a direct measure of defibrillation efficacy.