Clinical evaluation of the internal automatic cardioverter-defibrillator in survivors of sudden cardiac death.
Clinical evaluation of the internal automatic cardioverter-defibrillator in survivors of sudden cardiac death.
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心源性猝死幸存者体内自动心脏复律除颤器的临床评估。
DOI：
10.1016/0002-9149(83)90195-9
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发表时间：
1983
期刊：
影响因子：
--
通讯作者：
Thomas,A
中科院分区：
文献类型：
--
作者：
Reid,PR;Mirowski,M;Mower,MM;Platia,EV;Griffith,LS;WatkinsJr,L;BachJr,SM;Imran,M;Thomas,A
对12例心脏骤停反复发作且内科和外科治疗无效的患者进行了R波同步植入式自动心律转复除颤器（IACD）评价。7名男性和5名女性，平均年龄61岁，手术接受了完整的IACD系统。冠心病11例，Q-T延长1例。平均射血分数为34%，6例患者患有严重充血性心力衰竭（纽约心脏协会III或IV级）。IACD是由2个双极导线系统组成的完全植入式装置。一种系统在上级腔静脉和左心室尖部中使用导线，通过该导线递送复律脉冲。第二种系统采用植入心室的闭合双极电极导线来感知心率。10例室性心动过速和1例自发性室性心动过速患者术后电生理检查显示IACD功能正常，均成功转复，平均转复时间为18 ± 4 s。诱发的心律失常为室性心动过速（160 ~ 300次/min）9例，室颤1例。这些数据表明，在这些心脏骤停的幸存者中，程序心室刺激诱发的心律主要为室性心动过速，而不是室颤。使用IACD为一些可能无法存活的患者提供了有效的治疗手段。
An R-wave synchronous implantable automatic cardioverter-defibrillator (IACD) was evaluated in 12 patients with repeated episodes of cardiac arrest who remained refractory to medical and surgical therapy. Seven men and 5 women, average age 61 years, surgically received a complete IACD system. Coronary artery disease was found in 11 and the prolonged Q-T syndrome in 1. The average ejection fraction was 34%, and 6 patients had severe congestive heart failure (New York Heart Association class III or IV).The IACD is a completely implantable unit consisting of 2 bipolar lead systems. One system uses a lead in the superior vena cava and on the left ventricular apex through which the cardioverting pulse is delivered. The second system employs a close bipolar lead implanted in the ventricle for sensing rate. After the onset of ventricular tachycardia or fibrillation, the IACD automatically delivers approximately 25 J.Postoperative electrophysiologic study in 10 and spontaneous ventricular tachycardia in 1 patient demonstrated appropriate IACD function and successful conversion in all with an average of 18 ± 4 seconds. The induced arrhythmias were ventricular tachycardia (160 to 300 beats/min) in 9 and ventricular fibrillation in 1.These data demonstrate that ventricular tachycardia, not ventricular fibrillation, was the predominant rhythm induced during programmed ventricular stimulation in these survivors of cardiac arrest and that the IACD effectively responded to a wide range of ventricular tachycardia rates as well as ventricular fibrillation. Use of the IACD offers an effective means of therapy for some patients who otherwise may not have survived.