高除颤阈值处理(讲课版).doc

高除颤阈值处理(讲课版).doc■3! St. Jude Medical
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高除颤阈值的处理
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什么是高DFT?
■除颤阈值(DFT)：终止VF所需的最小能量
■在通常情况下，当除颤的能量没有足够的安 全范围时，该患者为高DFT
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■在患者DFT和ICD最大程控能量之间，必须有
10J的安全范围
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临床研究结果
从不同临床研究中发现的一些事实：
■ ICD植入时，高DFT的发生率高达10% PACE 2003;26:44-48
- JACC 2005; Circulation Supplements (Feb 1) 104A,1080
JCE 1998;9:916-920
■多达16%的ICD患者在植入后DFT升高10J或更多3
■多达9%的ICD患者在2月内DFT升高至=/>25J PACE 1998;21:410-417
JCE 2000;11:736-740
■长期胺碘酮治疗可增加大约62%的除颤所需能量5
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那些患者容易发生高DFT?
虽然很难准确预测DFT，但有研究显示高DFT患者 有一些相同的特征：
■低LVEF
■高NYHA分级
■有旁路手术史
■在过去6周内服用过胺碘酮
■有VF史
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Shukla H et al. High defibrillation thresholds in transvenous biphasic ICDs:
clinical predictors and prognostic implications. PACE 2003; 26:44-48.
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7
相关临床研究：DFT的长期评估（1/2）
对31例ICD患者进行2年的研究 ■平均DFT值无变化
+ 植入时
+
+
+
+
DFT MANAGEMENT The Problem of Rising DFTs
Tbkano T, et al.: Long-term evaluation of the ventricular defibrillation energy requirement.
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J. Cardiovascular Electrophysiology; September 1998; 9(9):916-920.
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DFT的长期评估吻
Implantation： 2 mont