ICD植入术中的体外测试  

The feasibility of in-vitro testing in ICD implantation procedure

作　　者：孙雅逊[1] 姜江芬[1] 盛夏[1] 蒋汝红[1] 陈世权[1] 何红[1] 傅国胜[1] 蒋晨阳[1] 

机构地区：[1]浙江大学医学院附属邵逸夫医院,310016

出　　处：《临床心电学杂志》2013年第5期331-334,共4页Journal of Clinical Electrocardiology

基　　金：国家自然科学基金资助(项目号:81100067)

摘　　要：目的研究ICD植入术中进行体外连接ICD进而对ICD的心室感知、起搏等功能进行评估,并对可能存在的误感知进行评估。方法选取8名ICD更换术患者,术中通过主动起搏导线连接体外ICD方法,对多个品牌ICD进行测试其心室感知、起搏阈值及阻抗等,并比较体内ICD与体外连接ICD腔内图。在体外连接ICD时将心室感知灵敏度调为最大并观察是否有心室误感知。结果体外连接ICD与体内ICD相比,心室感知振幅无明显差异(15.54±4.43mV vs.15.55±4.54mV,p=0.84),腔内图形相似,起搏阈值无明显差异(1.13±0.68V vs.1.03±0.60V,p=0.20),起搏阻抗有所增加(549±131Ωvs.512±132Ω,p<0.001);不同ICD的R波振幅不同,但均满足临床要求;不同ICD提供不同通道的腔内图,心室R波振幅与心室放大器通道的腔内图振幅相一致,与双极感知通道的振幅不同。8名患者在最大心室感知灵敏度情况下均未出现心室过感知。结论更换术中体外连接ICD能够模拟ICD在体内的感知情况,可能对评估潜在的误感知有所帮助。Objective To evaluate a simple clinical method to test sensing ability and avoid VO in implanting procedure. Methods In ICD replacement procedure, we connected the in-vitro testing ICD with in- vivo sensing lead through active fixation lead and bridging cable. The amplitude and morphology of ventricular sensing and pacing signals of different ICDs were analyzed and compared with those of in-vivo ICDs. The in- vitro ICDs were programmed to the most sensitive to reveal the possible VO. Results Comparing with in-vivo ICD, in-vitro ICD testing provided similar signal pattern of ventricular sensing both in sensing and pacing mode. Threshold testing showed the same results in in-vitro and in-vivo mode. Impedance of pacing of in-vitro increased slightly （-35Ω）. In 8 patients, in-vitro ICDs showed no VO under the most sensitive setting. Short term follow-up showed no VO episode or inappropriate therapy. Conclusions In-vitro ICD testing could mimic in- vivo ICD sensing by similar amplitude and morphology of ventricular sensing and provided a simple method to reveal possible ventricular oversensing before ICD implantation.

关 键 词：ICD 阻抗 振幅 心室误感知 长QT综合征 短QT综合征 

分 类 号：R541.7[医药卫生—心血管疾病] R540.41[医药卫生—内科学]