INTERNAL CARDIAC DEFIBRILLATION - HISTOPATHOLOGY AND TEMPORAL STABILITY OF DEFIBRILLATION ENERGY-REQUIREMENTS
INTERNAL CARDIAC DEFIBRILLATION - HISTOPATHOLOGY AND TEMPORAL STABILITY OF DEFIBRILLATION ENERGY-REQUIREMENTS
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DOI：
10.1016/s0735-1097(87)80058-x
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发表时间：
1987-03-01
影响因子：
24
通讯作者：
WINKLE, RA
中科院分区：
文献类型：
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作者：
FAIN, ES;BILLINGHAM, M;WINKLE, RA
通过进行大量诱导性纤颤-除颤试验，在术中测试自动植入式心律转复器/除颤器，以确保有效性。在12只狗中研究了除颤能量需求的时间稳定性和多次除颤电击的组织病理学效应，这些狗长期装有与人类相同的内部弹簧贴片电极导线系统。在第1、11、18、25和32天对犬进行研究。通过逻辑回归分析数据，并比较50%（E50）和80%（E80）成功所需的能量。在第32天，处死犬，取出心脏进行大体和显微镜病理检查。从第1天到第11天，能量需求显著降低，因为E50从6.9 ± 1降低。4.5至4.9 .+-。2.5 J（p < 0.02），E80从8.5 ±下降。5.2至6.1 .+-。3.4 J（p < 0.02）。然后，能量需求在实验的剩余时间内保持稳定。这些狗接受了209 .+-. 18次电击（范围1至24 J），总累积剂量为1，524 ± 1 J。571 J.在所有病例中，肉眼和显微镜下均未发现心肌或冠状血管病理变化的证据。在所有病例中，贴片电极下方均存在纤维斑块，有时包含斑片状出血区域;在单个样本中，混合炎性浸润伴随出血。还观察到弹簧电极的内皮化和轻度右心房内膜纤维化。因此，成功除颤的能量需求在植入测试后的前11天内降低，然后保持稳定。此外，通过弹簧-贴片电极系统施加的多个紧密间隔的电击不会引起与植入相关的变化以外的心肌损伤。
The automatic implantable cardioverter/difibrillator is tested intraoperatively to ensure effectiveness by performing a number of induced fibrillation-defibrillation trials. The temporal stability of defibrillation energy requirements and the histopathologic effects of multiple defibrillating shocks were studied in 12 dogs chronically instrumented with an internal spring-patch lead system identical to that used in humans. Dogs were studied on days 1, 11, 18, 25 and 32. Data were analyzed by logistic regression and the energy required for 50% (E50) and 80% (E80) success was compared. On day 32 the dogs were killed and the heart was removed for gross and microscopic pathologic examination. There was a significant decrease in energy requirements from day 1 to day 11, as the E50 decreased from 6.9 .+-. 4.5 to 4.9 .+-. 2.5 J (p < 0.02) and the E80 decreased from 8.5 .+-. 5.2 to 6.1 .+-. 3.4 J (p < 0.02). The energy requirements then remained stable over the remainder of the experiment. The dogs were administered 209 .+-. 18 shocks (range 1 to 24 J) for a total cumulative dose of 1,524 .+-. 571 J. In all cases, both grossly and microscopically, there was no evidence of pathologic changes in the myocardium or coronary vessels. In all cases there was a fibrous plaque beneath the patch electrodes, at times containing an area of patchy hemorrhage; in a single specimen a mixed inflammatory infiltrate accompanied the hemorrhage. Endothelialization of the spring electrode with mild right atrial endocardial fibrosis was also observed. Therefore, the energy requirements for successful defibrillation decrease during the first 11 days after testing at implantation, and then remian stable. Also, multiple, closely spaced defibrillating shocks applied through the spring-patch electrode system do not cause myocardial damage of changes other than those associated with the implantation.