1。介绍植入式心脏除颤器（ICD）的防止术后存活猝死或心脏性猝死（SCD），SCD的风险，由于左心室功能受损。然而，不适当的治疗方法的危险是很高，特别是在单室设备。这些多余的放电可能是有害的，损害患者的生活质量。心房检测可提高设备的性能和减少不适当休克的风险。1,2然而心房的检测需要一个心房电极，这本身就带有明显的相关风险。3一个制造商，百多力，开发感应功能心房心室单腔电极。第一电极Kainox，通过A +，这显示了良好的感知能力。4然而，它不常用由于电极刚度和大直径（3.5毫米，10.5 F）。这种电极的进一步发展é率先创造对Linox 智能 S DX铅，其中有一个较小的直径（2.6毫米，7.8 F），并表现出优异的植入功能和感应功能。本文描述了该电极的位置，以突出的数据从主研究，并表现出既便于植入和传感技术，该电极的优秀能力。 2。病例报告<ol><li>病人是一个40岁的女性吸烟者的冠状动脉疾病（CAD）的历史，经常性前壁心肌梗死（AMI）状态后经皮冠状动脉介入治疗（PCI），左心室功能受损（LVEF≥25％），高胆固醇血症阵发性心房颤动（PAF）的。 </li><li>四个月前，开始心脏衰竭的药物治疗。她的方案，包括β-受体阻滞剂，ACE抑制剂和利尿剂;然而，有没有改善左心室功能。 </li><li>由于她的显著左心室功能受损，病人心源性猝死（SCD），是在相当大的风险。 </li><li>通过演示，病人在窦性心律与在胸导联R波损失。 24小时动态心电图监测发现房颤的一个32分钟的情节。 </li><li>在作出决定植入单腔ICD的心房检测能力，以监测进一步发作房颤，以避免不适当的治疗中一个非常活跃的病人。 </li></ol> 3。诊断，评估和计划<ol><li>治疗计划是1向应VR-T的DX转复除颤器植入智能 1百多力Linox S DX尼克尔率先在电生理实验室的局部麻醉下。 </li><li>一个胸回声植入前进行，以便重新评估左心室射血分数和排除心室血栓，这可能禁止在植入去纤颤器测试。 </li></ol> 4。植入手术<ol><li>围术期的准备工作，包括预防性抗生素和皮下肝素单一静脉注射剂量。抗血栓治疗维持，因为冠脉事件的风险超过在手术过程中出血的危险</li><li>病人适当的准备和披在无菌的方式。 </li><li>病人被置于适度镇静，用适当的监测，包括连续心电监测，连续脉搏血氧饱和度，和非侵入性血压监测。 </li><li>四咪唑安定，芬太尼和异丙酚镇静下辖包括明智应用局部麻醉。 </li><li>通过完整的皮肤和安置下腔静脉（IVC）线在左锁骨下静脉穿刺植入开始。经X位置射线。这个不寻常的做法，因为大多数的介入electrophysiologists这个皮的方法，而不是更外侧的口袋静脉穿刺的方法，更有经验。 </li><li> 1约2cm以下手术刀和平行的锁骨，皮肤被切断。设备的口袋，左锁骨下准备后，在静脉线绘制的口袋里，Seldinger技术引入法国8鞘。 </li><li>然后引入SVC的鞘通过右心房电极。弯曲的管芯（65 - K，BIOTRONIK）被介绍到电极后，电极推虽然三尖瓣到右心室流出道。 </li><li>一个直管芯（65-C的BIOTRONIK），然后被引入电极。电极下降到劣的右心室和被操纵的右心室心尖部。电极的位置，以及根通过X射线监测ERAL位置的两个电极中庭。两个心房环电极被放置在SVC与右心房交界处。 </li><li>电极的适当位置后，心房和心室的信号的测量进行。 </li><li>心室电极起搏阈值测定（=“7:27”影片中的时间）。心房信号测量6.5和8mV的（=“7:56”影片中的时间）之间。心房信号增强设备中的过滤器设置的3倍。心室之间的8.4和9.5毫伏信号测量。有了这些感知和起搏阈值，电极被固定在锁骨下静脉的入口。 </li><li>然后将电极连接到除颤器。 </li><li>一切措施，复查和心室颤动诱导T波冲击，通过转复除颤器和设备由自动终止。 （视频=“00”时） </li><li>八ient被带到病房，并留在医院，直到第二天。在手术后第1天，X射线被确认领先地位，并排除气胸。感知和起搏阈值复查，术中测量是相似的。观察病人的恢复时间约4小时，也被植入后的监测。总体而言，植入成功，病人从医院出院的第二天。首三个月的后续eventless和传感信号超过此期限内保持稳定。 </li></ol>

<ol>
	<li>B&#228;nsch, D., Steffgen, F., Gronefeld, G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+1+1+trial+-+A+prospective+trial+of+a+dual-+versus+a+single-chamber+implantable+defibrillator+in+patients+with+slow+ventricular+tachycardias.">The 1+1 trial - A prospective trial of a dual- versus a single-chamber implantable defibrillator in patients with slow ventricular tachycardias.</a> Circulation. 110, 1022-1029 (2004).</li><li>Gilliam, F. R., Hayes, D. L., Boehmer, J. P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Real+World+Evaluation+of+Dual-Zone+ICD+and+CRT-D+Programming+Compared+to+Single-Zone+Programming.">Real World Evaluation of Dual-Zone ICD and CRT-D Programming Compared to Single-Zone Programming.</a> The ALTITUDE REDUCES Study. Journal of Cardiovascular Electrophysiology. 22, 1023-1029 (2011).</li><li>Dewland, T. A., Pellegrini, C. N., Wang, Y. F. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Dual-Chamber+Implantable+Cardioverter-Defibrillator+Selection+Is+Associated+With+Increased+Complication+Rates+and+Mortality+Among+Patients+Enrolled+in+the+NCDR+Implantable+Cardioverter-Defibrillator+Registry.">Dual-Chamber Implantable Cardioverter-Defibrillator Selection Is Associated With Increased Complication Rates and Mortality Among Patients Enrolled in the NCDR Implantable Cardioverter-Defibrillator Registry.</a> Journal of the American College of Cardiology. 58, 1007-1013 (2011).</li><li>Sticherling, C., Zabel, M., Spencker, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Comparison+of+a+Novel,+Single-Lead+Atrial+Sensing+System+With+a+Dual-Chamber+Implantable+Cardioverter-Defibrillator+System+in+Patients+Without+Antibradycardia+Pacing+Indications+Results+of+a+Randomized+Study.">Comparison of a Novel, Single-Lead Atrial Sensing System With a Dual-Chamber Implantable Cardioverter-Defibrillator System in Patients Without Antibradycardia Pacing Indications Results of a Randomized Study.</a> Circulation-Arrhythmia and Electrophysiology. 4, 56-63 (2011).</li><li>Safak, E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Assessment+of+atrial+sensing+quality+in+ICD+patients+with+a+floating+atrial+dipole+ICD+lead+(interim+results).">Assessment of atrial sensing quality in ICD patients with a floating atrial dipole ICD lead (interim results).</a> Europace. , 1027-1027 (2011).</li><li>Deisenhofer, I., Kolb, C., Ndrepepa, G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Do+current+dual+chamber+cardioverter+defibrillators+have+advantages+over+conventional+single+chamber+cardioverter+defibrillators+in+reducing+inappropriate+therapies?+A+randomized,+prospective+study.">Do current dual chamber cardioverter defibrillators have advantages over conventional single chamber cardioverter defibrillators in reducing inappropriate therapies? A randomized, prospective study.</a> J. Cardiovasc. Electrophysiol. 12, 134-142 (2001).</li><li>Dewland, T. A., Pellegrini, C. N., Wang, Y. F. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Dual-Chamber+Implantable+Cardioverter-Defibrillator+Selection+Is+Associated+With+Increased+Complication+Rates+and+Mortality+Among+Patients+Enrolled+in+the+NCDR+Implantable+Cardioverter-Defibrillator+Registry.">Dual-Chamber Implantable Cardioverter-Defibrillator Selection Is Associated With Increased Complication Rates and Mortality Among Patients Enrolled in the NCDR Implantable Cardioverter-Defibrillator Registry.</a> Journal of the American College of Cardiology. 58, 1007-1013 (2011).</li><li>Poole, J. E., Gleva, M. 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新Linox SMART S DX尼克尔电极植入一起向应的DX ICD，BIOTRONIK，如容易放置任何单腔ICD。这方面的经验是由DX审判。5 Linox SMART S DX尼克尔电极提供无房遥感的优势的心房领先的缺点，未发表的主数据支持。心房信号稳定时间在我们的病人已经在DX-试验证明。 双室设备只有一个前瞻性随机试验已经证明，在单室的检测优势，被称为1 +1审判。在这项试验中，缓慢的VT患者植入了双腔ICD，编程双或单室检测。联合终点是不适当的治疗方法的检出率低于SVTs和VT的回应。对于这个端点，1 +1的试验证明了S双室（DCH）的长期性心动过速检测间隔（TDI）与传统编程的单腔（SCH）的检测，检测ignificant优势。这一发现被重新由Deisenhofer等。，大昌行，或中学ICD植入患者随机分配的。然而，没有对他们的审判，特别是解决与缓慢的心室心动过速患者平均心动过速检测时间间隔为368毫秒，并得出结论，单，双室设备是危及生命的室性心律失常的治疗同样有效。大昌行设备显示有优越的节奏分类，但不超过中学设备减少在SVTs不适当的治疗方面的不同。尽管一个双腔ICD的优势，只是为了植入的概念心动过速的诊断和分化检测一般是不会被接受，因为完善的检测计数器由增加铅complic的风险平衡ations，以及增加发病率和死亡率。2,7,8因此，植入双室检测技术或一个VDD系统的改进是必要的。9,10。结合向应的DX ICD的Linox SMART S DX尼克尔电极提供了这种优势。传感设施是双室设备及并发症的发生率是低，在传统的单腔心脏除颤器类似。 结论向应VR-T的DX已经被证明可靠地感知心房信号和收集有价值的信息，以便为房性心律失常的早期检测。此外，该设备提供安全的冲击减少SMART AV歧视。可用心房IEGM通道诊断适当ICD的检测和治疗，从而减少不适当的冲击和获取信息，以优化器件编程。

a new single chamber implantable defibrillator with atrial sensing: a practical demonstration of sensing and  ease of implantation

植入式心脏除颤器（ICD）终止室性心动过速（VT）和心室颤动（VF），疗效高，可以保护心脏猝死（SCD）的患者。但是，不适当的冲击可能会发生心动过速，如果是误诊。不适当的冲击是有害的，损害患者的生活质量。在ICD的编程与低检测率不恰当的治疗的风险增加。与双室设备，有额外的心房信息的利益相比，单室检测误诊带来更大的风险。然而，仅仅为了检测使用双室设备，一般不接受，因为与第二电极相关的风险可能超过检测的好处。因此，百多力开发的名为SMART S DX尼克尔Linox心室铅，允许从两个电极在定位日心房部分心房信号检测é心室电极。该器件包含两个环形电极，一接触上腔静脉（SVC）和自由浮动部分心房电极定位的交界处的心房壁。优异的信号质量只能达到一个特殊的过滤器设置在ICD（向应540和740 VR-T的DX，百多力）。这里将证明，植入系统的易用性。

Watch this Scientific Journal Video about A New Single Chamber Implantable Defibrillator with Atrial Sensing: A Practical Demonstration of Sensing and  Ease of Implantation at JoVE.com

A New Single Chamber Implantable Defibrillator with Atrial Sensing: A Practical Demonstration of Sensing and  Ease of Implantation

双腔植入式心脏除颤器（ICD）可提高检测房颤以及心动过速分化的。然而，这种优势被削弱第二电极，这是在传统的双室设备需要与相关的并发症。因此，百多力已开发出一种新的电极称为“Linox<sup&gt;智能</sup&gt; S DX尼克尔，向应的DX ICD一起使用时，提供双室检测，没有相关的风险与第二电极。

心房遥感新的单一商会植入去纤颤器：一个实用的遥感示范和易于植入

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