Indian Pacing and Electrophysiology Journal最新文献_第2页

Retrievable dual-chamber leadless pacemaker implant (Aveir DR) in an adult patient with congenital heart disease. 为一名患有先天性心脏病的成年患者植入双腔无导线起搏器 (Aveir DR)。

Q3 Medicine

Indian Pacing and Electrophysiology Journal

Pub Date : 2024-09-04 DOI: 10.1016/j.ipej.2024.09.001

Howard How-Peng Liu, Daniel Cortez

Leadless pacemakers have demonstrated potential as a transvenous pacing option in Adult Congenital Heart Disease patients. Aveir™ single-chamber (VR) leadless pacemakers have demonstrated safety in patients without congenital heart disease in a dual chamber approach. We present a case of dual-chamber pacing using the Aveir dual-chamber (DR) leadless pacemaker in a patient with repaired dextro-transposition of the great arteries with ventricular septal defect (VSD) surgical closure. A 26-year-old male patient with a history of transposition of the great arteries status post arterial switch and VSD repair neonatally had complicated second degree atrioventricular block and sinus node dysfunction necessitating pacemaker placement. Epicardial single-chamber ventricular pacemaker was placed neonatally, which was switched to dual-chamber pacemaker at age 17 due to malfunction. Recent fracture of pacemaker leads led to implantation of new dual chamber leadless pacemaker. Removal of previous pacemaker leads via mechanical extraction occurred and implantation of Aveir DR leadless pacemaker was performed under anesthesia via right femoral vein access without complication. Follow-up demonstrated Aveir VR threshold of 1.0V@0.2 ms, R-wave of 8.9mV, impedance of 490Ω, and the Aveir AR threshold of 0.75V@0.2 ms, P-wave of 3.7mV, and impedance of 400Ω. This case demonstrates safety and efficacy of dual chamber leadless pacemaker implantation in an ACHD patient.

无导联起搏器已被证明可作为成人先天性心脏病患者的经静脉起搏选择。Aveir™ 单腔（VR）无引线起搏器已在无先天性心脏病患者中证明了双腔方法的安全性。我们介绍了一例使用 Aveir 双腔（DR）无引线起搏器进行双腔起搏的病例，患者患有修复性右大动脉横断并伴有室间隔缺损（VSD）手术闭合。一名 26 岁的男性患者曾患有大动脉转位，在新生儿期进行动脉转换和室间隔缺损修复术后，出现复杂的二度房室传导阻滞和窦房结功能障碍，因此必须安置起搏器。新生儿期安置了心外膜单腔心室起搏器，17 岁时因故障改用双腔起搏器。最近起搏器导线断裂，因此植入了新的双腔无导联起搏器。在麻醉状态下，通过右股静脉入路取出了之前的起搏器导线，并植入了 Aveir DR 无引线起搏器，未发生并发症。随访显示 Aveir VR 阈值为 1.0V@0.2ms，R 波为 8.9mV，阻抗为 490Ω；Aveir AR 阈值为 0.75V@0.2ms，P 波为 3.7mV，阻抗为 400Ω。本病例证明了在 ACHD 患者中植入双腔无导联起搏器的安全性和有效性。

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引用次数: 0

A case report of a combined implantation technique of a cardioverter-defibrillator in an infant with long QT syndrome type 8 (Timothy's syndrome). 长 QT 8 型综合征（蒂莫西综合征）婴儿心律转复除颤器联合植入技术病例报告。

Q3 Medicine

Indian Pacing and Electrophysiology Journal

Pub Date : 2024-09-04 DOI: 10.1016/j.ipej.2024.09.002

Sergei Viktorovich Nemtsov, Roman Borisovich Tatarskiy, Sergei Arturovich Termosesov, Dmitriy Sergeevich Lebedev

We present a case of successful implantation of a cardioverter-defibrillator (ICD) using combined technique in a child with Timothy's syndrome. Due to high risk of sudden cardiac death (SCD) such patients often need ICD for primary or secondary prevention but implantation technique in young children remains controversial. The subcutaneous cardioverter-defibrillators could be an option in some cases, however, reliable cardiac pacing should be implemented for patients with bradyarrhythmias. An ICD implantation technique with the epicardial pacing lead placement and subcutaneous tunnel formation for endocardial defibrillation lead seems to be promising in SCD prevention also providing the opportunity for permanent pacing.

我们介绍了一例采用联合技术为蒂莫西综合征患儿成功植入心律转复除颤器（ICD）的病例。由于心脏性猝死（SCD）的高风险，此类患者通常需要 ICD 进行一级或二级预防，但在幼儿中的植入技术仍存在争议。在某些情况下，皮下心律转复除颤器可能是一种选择，但对于心律过缓的患者，应采用可靠的心脏起搏。心外膜起搏导线植入和心内膜除颤导线皮下隧道形成的 ICD 植入技术在预防 SCD 方面似乎很有前景，同时也为永久起搏提供了机会。

引用次数: 0

Left bundle fascicular versus left bundle trunk pacing: A comparison of their electrical synchrony parameters 左束筋膜起搏与左束主干起搏：两者电气同步参数的比较。

Q3 Medicine

Indian Pacing and Electrophysiology Journal

Pub Date : 2024-09-01 DOI: 10.1016/j.ipej.2024.07.006

Background

Variation in human left bundle branch (LBB) anatomy has a significant effect on the sequence of left ventricular depolarization. However, little is known regarding the electrophysiological characteristics of pacing different LBB fascicles.

Objective

We aimed to analyse the different electrocardiographic characteristics of LBB pacing (LBBP) attending to the site of pacing at the LBB system.

Methods

In 200 consecutive patients with confirmed LBBP, we distinguished left bundle trunk capture (LBTP) from any LB fascicular pacing (LBFP) based on the presence of LB potentials and paced QRS morphologies. We compared them regarding procedure, LBBP criteria and electrical synchrony parameters.

Results

One hundred and seventy-three patients with LBFP were compared to 25 patients with LBTP. Left septal and posterior fascicles were significantly more prevalent than left anterior in LBFP (46.8 %, 41.0 % and 12.2 % respectively). QRS transition criteria (80.0 % vs 61.8 %; p = 0.077), selective LBBP (40.0 vs 21.5 %; p = 0.101), paced QRS width (110.3 ± 16.8 ms vs 115.4 ± 14.9 ms; p = 0.117), V6-RWPT (79.2 ± 10.7 ms vs 75.3 ± 9.7 ms; p = 0.068) and interpeak interval (42.5 ± 19.1 ms vs 45.7 ± 12.9 ms; p = 0.282) were not significantly different between LBTP and LBFP. All short-term complications occurred in LBFP, mainly driven by septal perforations (n = 23), without any difference in the pacing parameters. Among the LBFP subgroups, only aVL-RWPT was longer when the posterior fascicle was paced.

Conclusions

LBFP is much more prevalent than LBTP in unselected consecutive patients with LBBP. LBFP seems more feasible, and as good as LBTP in terms of electrical synchrony and pacing safety.

背景：人体左束支（LBB）解剖结构的变化对左心室除极顺序有显著影响。然而，人们对不同 LBB 束支起搏的电生理特征知之甚少：我们的目的是分析 LBB 起搏（LBBP）的不同心电图特征与 LBB 系统起搏部位的关系：在 200 名确诊 LBBP 的连续患者中，我们根据 LB 电位和起搏 QRS 形态的存在，区分了左束干捕获（LBTP）和任何 LB 筋膜起搏（LBFP）。我们比较了它们的手术方法、LBBP 标准和电同步参数：结果：173 名 LBFP 患者与 25 名 LBTP 患者进行了比较。在 LBFP 患者中，左室间隔和后束明显多于左前束（分别为 46.8%、41.0% 和 12.2%）。QRS转换标准（80.0% vs 61.8%；p=0.077）、选择性LBBP（40.0 vs 21.5%；p=0.101）、起搏QRS宽度（110.3±16.8 ms vs 115.4±14.9 ms；p=0.117）、V6-RWPT（79.2±10.7 ms vs 75.3±9.7 ms; p=0.068）和峰间期（42.5±19.1 ms vs 45.7±12.9 ms; p=0.282）在 LBTP 和 LBFP 之间无显著差异。所有短期并发症都发生在 LBFP，主要是室间隔穿孔（23 例），起搏参数没有任何差异。在LBFP亚组中，只有后束起搏时aVL-RWPT较长：结论：在未经选择的连续 LBBP 患者中，LBFP 比 LBTP 更为普遍。LBFP 似乎更可行，在电同步性和起搏安全性方面与 LBTP 不相上下。

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引用次数: 0

Analysis of ST segment depression in supraventricular tachycardia and its relationship with underlying mechanism 室上性心动过速 ST 段压低及其与潜在机制的关系分析

Q3 Medicine

Indian Pacing and Electrophysiology Journal

Pub Date : 2024-09-01 DOI: 10.1016/j.ipej.2024.06.007

Background

Electrocardiographic diagnosis of causes of supraventricular tachycardia (SVT) is sometimes difficult and application of routine algorithms can lead to misdiagnosis in as many as 37 % of patients. ST segment depression may be useful in diagnosing the nature of SVT.

Methods

We reviewed surface electrocardiogram (ECG) characteristics of 300 patients having SVT with 1:1 AV relationship and correlated findings with electrophysiology study (EPS) findings. Final diagnosis of AVNRT (Atrioventricular nodal reentrant tachycardia), Orthodromic AVRT (atrioventricular reentrant tachycardia) and atrial tachycardia (AT) was correlated with ECG parameters like heart rate, ST segment depressions and QRS morphology.

Results

Out of 300 patients, majority patients included in study, were having AVNRT or AVRT. ST depression predicted AVRT if the ST depression was ≥ 2 mm (overall sensitivity of 38.3 % and specificity of 93.8 % to predict AVRT) and was downsloping in morphology (sensitivity of 36.9 % and specificity of 94.7 % to predict AVRT). At heart rates ≥214 beats per minute (bpm) as measured by 7 small squares of ECG at 25 mm/s, downsloping ST depression ≥2 mm had a sensitivity 37.9 % of and specificity of 89.2 % to predict AVRT. At heart rate <214 bpm, downsloping ST depression ≥2 mm had sensitivity of 37.2 % and specificity of 96.5 % to predict AVRT. Downsloping ST depression of ≥2 mm helps to differentiate AVNRT from AVRT.

Conclusion

A downsloping ST segment depression ≥2 mm predicted SVT being an AVRT and can be used as a useful criteria in diagnosing the tachycardia.

背景：心电图诊断室上性心动过速（SVT）的病因有时很困难，应用常规算法可导致多达 37% 的患者被误诊。ST 段压低可能有助于诊断 SVT 的性质：我们回顾了 300 例具有 1:1 房室关系的 SVT 患者的体表心电图（ECG）特征，并将研究结果与电生理学研究（EPS）结果相关联。房室结性返流性心动过速（AVNRT）、正交性房室结性返流性心动过速（AVRT）和房性心动过速（AT）的最终诊断与心率、ST 段压低和 QRS 形态等心电图参数相关：在 300 名患者中，大多数患者患有房性无房性心动过速（AVNRT）或房性无房性心动过速（AVRT）。如果 ST 段压低大于 2 毫米（预测 AVRT 的总体敏感性为 38.3%，特异性为 93.8%）且形态呈下斜（预测 AVRT 的敏感性为 36.9%，特异性为 94.7%），则 ST 段压低可预测 AVRT。在心率大于 214 次/分（bpm）时，以 25 毫米/秒的速度测量 7 个小方格的心电图，下斜 ST 波压低大于 2 毫米对预测 AVRT 的灵敏度为 37.9%，特异性为 89.2%。心率为 2 毫米时，预测 AVRT 的灵敏度为 37.2%，特异度为 96.5%。下斜 ST 段压低>2 毫米有助于区分 AVNRT 和 AVRT：下斜 ST 段压低 >2 毫米可预测 SVT 为 AVRT，可作为诊断心动过速的有用标准。

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引用次数: 0

Use of 3D electroanatomic mapping systems allows us to see the past and predict the future of SVT ablation 三维电解剖绘图系统的使用使我们能够看到 SVT 消融的过去并预测其未来。

Q3 Medicine

Indian Pacing and Electrophysiology Journal

Pub Date : 2024-09-01 DOI: 10.1016/j.ipej.2024.09.007

引用次数: 0

Long- and short-term outcomes after transvenous lead extraction in a large single-centre patient cohort using the clinical frailty scale as a risk assessment tool 使用临床虚弱程度量表作为风险评估工具，在大型单中心患者队列中评估经静脉引线拔除术后的长期和短期疗效。

Q3 Medicine

Indian Pacing and Electrophysiology Journal

Pub Date : 2024-09-01 DOI: 10.1016/j.ipej.2024.07.001

Background and aims

The rate of cardiac implantable electronic device (CIED) implantations and the need for transvenous lead extraction (TLE) are growing worldwide. This study examined a large Swedish cohort with the aim of identifying possible predictors of post-TLE mortality with special focus on systemic infection patients and frailty.

Methods

This was a single centre study. Records of patients undergoing TLE between 2010 and 2018 were analysed. Statistical analyses were conducted to compare baseline characteristics of patients with different indications and identify risk factors of 30-day and 1-year mortality.

Results

A total of 893 patients were identified. Local infection was the dominant indication and pacemaker was the most common CIED. The mean age was 65 ± 16 years, 73 % were male and median follow-up was 3.9 years. Heart failure was the most common comorbidity. Patients with systemic infection were significantly older, frailer and had significantly higher levels of comorbidities. 30-day mortality and 1-year mortality rates were 2.5 % and 9.9 %, respectively. Systemic infection and chronic kidney disease (CKD) were independently associated with 30-day and 1-year mortality. Clinical frailty scale (CFS) 5–7 correlated independently with 1-year mortality in the entire cohort and specifically in systemic infection patients. CKD, cardiac resynchronization therapy and CFS 5–7 were significant risk factors for long-term mortality (death >1 year after TLE) in multivariable analysis.

Conclusions

Systemic infection, kidney failure in addition to the novel parameter of frailty were associated with post-TLE all-cause mortality. These risk factors should be considered during pre-procedure risk stratification to improve post-TLE outcomes.

背景和目的：在全球范围内，心脏植入式电子设备（CIED）的植入率和经静脉导联取出术（TLE）的需求都在不断增长。本研究对瑞典的一个大型队列进行了调查，旨在确定经静脉导联拔除术后死亡率的可能预测因素，特别关注全身感染患者和体弱患者：这是一项单中心研究。方法：这是一项单中心研究，分析了2010年至2018年期间接受TLE治疗的患者记录。统计分析比较了不同适应症患者的基线特征，并确定了30天和1年死亡率的风险因素：共确定了893名患者。局部感染是主要适应症，起搏器是最常见的CIED。平均年龄为 65 ± 16 岁，73% 为男性，随访时间中位数为 3.9 年。心力衰竭是最常见的合并症。全身感染患者的年龄明显偏大，体质明显偏弱，合并症明显增多。30天死亡率和1年死亡率分别为2.5%和9.9%。全身感染和慢性肾病（CKD）与30天和1年的死亡率有独立关联。临床虚弱度量表（CFS）5-7与整个组群的1年死亡率有独立相关性，尤其与全身感染患者的1年死亡率相关。在多变量分析中，慢性肾功能衰竭、心脏再同步化治疗和CFS 5-7是长期死亡率（TLE后1年以上死亡）的重要风险因素：结论：全身感染、肾衰竭以及虚弱这一新元素与TLE术后全因死亡率有关。在进行手术前风险分层时应考虑这些风险因素，以改善TLE术后的预后。

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引用次数: 0

Speech induced atrial tachycardia – Case report and review of literature 演讲诱发的房性心动过速--病例报告和文献综述。

Q3 Medicine

Indian Pacing and Electrophysiology Journal

Pub Date : 2024-09-01 DOI: 10.1016/j.ipej.2024.06.009

Speech induced atrial tachycardia is peculiar and an extremely uncommon clinical situation. Though the exact patho-mechanism for such an association cannot be ascertained. It is postulated to be caused by cardiac autonomic modulation by vagal innervation around the ganglionated plexus (GP) of the heart. We hereby present a unique case of atrial tachycardia which could be induced only by speech and was successfully mapped and ablated on to the floor of left atrium (LA), which is a possible site of posteromedial left atrial ganglionated plexus.

演讲诱发房性心动过速是一种特殊的临床症状，极为罕见。虽然这种关联的确切病理机制尚无法确定。据推测，它是由心脏神经节丛（GP）周围的迷走神经支配的心脏自主神经调节引起的。我们在此介绍一例独特的心房性心动过速病例，该病例只能通过说话诱发心房性心动过速，并且成功地在左心房（LA）底部进行了测绘和消融，该部位可能是左心房后内侧神经节丛。

引用次数: 0

Real-time Ripple technique: A case report on Ripple map for real-time identification of conduction gaps without first-pass pulmonary vein isolation 实时波纹技术：无需第一道肺静脉隔离即可实时识别传导间隙的波纹图病例报告。

Q3 Medicine

Indian Pacing and Electrophysiology Journal

Pub Date : 2024-09-01 DOI: 10.1016/j.ipej.2024.06.008

This paper presents a novel approach to gap mapping in pulmonary vein isolation (PVI) for atrial fibrillation (AF) treatment, utilizing the real-time Ripple (RR) technique. Radiofrequency (RF) catheter ablation, particularly encircling PVI, is a common intervention for AF. Identifying left atrium–pulmonary vein conduction gaps is crucial for achieving PVI with minimal additional ablation if first-pass PVI is unsuccessful. However, identifying conduction gaps can be relatively challenging, often necessitating manual electrocardiogram reannotation due to the limitations of local activation time (LAT) maps. In the case of a 63-year-old patient with drug-resistant symptomatic persistent AF, the RR technique was utilized to identify conduction gaps during RF ablation. The technique involved pausing fast anatomical mapping (FAM), activating Ripple map (RM) feature on the CARTO 3 system and acquiring points with an ultrahigh-resolution mapping catheter. This approach revealed that the actual site of earliest activation differs from the LAT map indication, enabling successful PVI.

The RM feature's capability to reflect actual excitation propagation without reliance on map annotations was crucial for precise conduction gap identification, overcoming inter-operator variability and inaccuracies of conventional methods. The RR technique not only facilitated real-time analysis during gap mapping but also significantly reduced the procedure time, minimizing potential complications.

This case report highlights the efficacy of the RR technique in real-time gap mapping, demonstrating its value in cases where first-pass PVI is unsuccessful. The integration of this technique into PVI procedures can enhance both the accuracy and efficiency of catheter ablation for AF.

本文介绍了一种利用实时波纹（RR）技术绘制肺静脉隔离（PVI）间隙图以治疗心房颤动（AF）的新方法。射频（RF）导管消融术，尤其是环绕肺静脉隔离术，是治疗房颤的常见干预措施。识别左心房-肺静脉传导间隙对于在首次 PVI 不成功的情况下以最少的额外消融实现 PVI 至关重要。然而，由于局部激活时间（LAT）图的局限性，识别传导间隙可能相对具有挑战性，通常需要手动重新标注心电图。在一名 63 岁的耐药症状性持续房颤患者的病例中，射频消融过程中使用了 RR 技术来识别传导间隙。该技术包括暂停快速解剖绘图（FAM），激活 CARTO 3 系统的波纹图（RM）功能，并使用超高分辨率绘图导管采集点。这种方法揭示了最早激活的实际部位与 LAT 地图指示不同，从而成功地进行了 PVI。RM功能能够反映实际的兴奋传播，而无需依赖地图注释，这对于精确识别传导间隙至关重要，克服了操作者之间的差异和传统方法的不准确性。RR 技术不仅有助于在间隙图绘制过程中进行实时分析，还大大缩短了手术时间，将潜在的并发症降至最低。本病例报告强调了 RR 技术在实时间隙映射中的功效，证明了它在首次 PVI 不成功的病例中的价值。将该技术整合到 PVI 手术中可提高房颤导管消融的准确性和效率。

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引用次数: 0

Longitudinal reduction in fluoroscopy with continued use of 3-dimensional electroanatomic mapping systems in catheter ablation of supraventricular tachycardia – then and now 在室上性心动过速导管消融术中持续使用三维电解剖图系统，纵向减少了透视 - 当时和现在。

Q3 Medicine

Indian Pacing and Electrophysiology Journal

Pub Date : 2024-09-01 DOI: 10.1016/j.ipej.2024.06.010

Background

Catheter ablation is a first-line treatment for symptomatic, recurrent supraventricular tachycardia (SVT). This study aims to demonstrate if 3D-electroanatomic mapping (EAM) during SVT ablation reduces fluoroscopy time (FT) and determine if further reductions in FT are observed longitudinally.

Methods

All cases of SVT ablation between May 2011–May 2022 at a single tertiary centre were prospectively recruited. FT between the cohorts with and without EAM were compared. Within the EAM subset, the trend of FT across the years was analysed.

Results

There were 1758 cases included, 563 without EAM, 1195 with EAM. EAM was associated with a longer procedure time (mean + 8.8 min, p = 0.001), but with mean reductions in FT and dose area product (DAP) by 19.6 min and 18 621 mGy*cm2 respectively (p < 0.001). There was comparable efficacy without any increase in complication rates. Over time (2011–2022), further reduction in FT of 0.9 min year on year was observed (p = 0.001). Between 2011 and 2017, there was a significant reduction in FT of 1.1 min year on year (p = 0.019), which was not observed from 2017 onwards (p = 0.061). The greatest reduction in FT was after the first year of adoption.

Conclusion

EAM in SVT ablation reduces fluoroscopy use. FT was initially observed to reduce further over time before plateauing, likely due to increased operator experience. While there is increased interest in zero fluoroscopy SVT ablation, complementary use of fluoroscopy may still be necessary in complex cases.

背景：导管消融是治疗症状性、复发性室上性心动过速（SVT）的一线疗法。本研究旨在证明 SVT 消融过程中的三维电子解剖图（EAM）是否能缩短透视时间（FT），并确定是否能纵向观察到 FT 的进一步缩短：前瞻性地招募了 2011 年 5 月至 2022 年 5 月期间在一家三级中心进行 SVT 消融的所有病例。比较了有 EAM 和无 EAM 组群之间的 FT。在 EAM 子集中，分析了 FT 在不同年份的变化趋势：结果：共纳入 1758 例病例，其中 563 例未使用 EAM，1195 例使用了 EAM。EAM与手术时间延长（平均+8.8分钟，p = 0.001）有关，但FT和剂量面积乘积（DAP）分别平均减少了19.6分钟和18 621 mGy*cm2（p 结论：EAM在SVT消融术中的应用与手术时间延长有关，但FT和剂量面积乘积（DAP）分别平均减少了19.6分钟和18 621 mGy*cm2：SVT 消融术中的 EAM 可减少透视的使用。最初观察到，随着时间的推移，FT 进一步减少，然后趋于平稳，这可能是由于操作者经验的增加。虽然人们对零透视 SVT 消融术的兴趣日益浓厚，但在复杂病例中仍有必要辅助使用透视。

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引用次数: 0

Analysis of intracardiac electrocardiogram during ill-sustained tachycardia – Door to a successful troubleshooting of ‘unnecessary’ defibrillator discharge 分析病态持续性心动过速时的心电图--成功排除 "不必要的 "除颤器放电故障之门。

Q3 Medicine

Indian Pacing and Electrophysiology Journal

Pub Date : 2024-09-01 DOI: 10.1016/j.ipej.2024.07.004

A 50-year-old gentleman with old anterior wall myocardial infarction with implantable cardioverter defibrillator (ICD, Abbott Medical, Fortify ST VR 1235-40) presented with recurrent appropriate ICD shock. The ICD stored EGM indicated a possibility of supraventricular tachycardia (SVT) rather than ventricular tachycardia (VT) when the morphology match was found high. Bundle brunch re-entry (BBR) VT was another differential. An EP study conducted on antiarrhythmic drugs (AAD) induced reproducible but only ill-sustained tachycardia too short to perform any SVT maneuvers during tachycardia. However, critical analysis of the tachycardia electrograms suggested atypical AVNRT as the most likely mechanism. The other differentials were atrial tachycardia (AT) and BBR VT. Manoeuvres during sinus rhythm and ventricular pacing excluded other diagnosis. A single point radiofrequency ablation (RFA) near the SP region cured the arrhythmia. The reason for misclassification of SVT as VT was also sought for. It was found that the shocks were received due to fulfilment of 2/3 criteria (sudden onset and regular tachycardia). Hence, he received therapy despite an appropriate morphology match favouring SVT. This is one of the known limitations of ICDs where regular SVTs (AVNRT/AVRT or AT) may receive inappropriate ICD therapies. After slow pathway modification there was no further recurrence of either SVT or VT; hence, a substrate modification was deferred.

一名 50 岁的男性患者患有陈旧性前壁心肌梗死，并安装了植入式心律转复除颤器（ICD，雅培医疗，Fortify ST VR 1235-40），但反复出现适当的 ICD 电击。当发现形态匹配度较高时，ICD 存储的 EGM 显示可能是室上性心动过速 (SVT)，而不是室性心动过速 (VT)。束束束再入（BBR）VT 是另一种鉴别方法。一项使用抗心律失常药物（AAD）进行的 EP 研究诱发了可重现的、但仅是持续时间不长的心动过速，在心动过速期间无法进行任何 SVT 操作。然而，对心动过速电图的批判性分析表明，最有可能的机制是非典型房室性心律失常。其他可鉴别的机制是房性心动过速（AT）和 BBR VT。窦性心律和心室起搏时的操作排除了其他诊断。靠近 SP 区的单点射频消融术（RFA）治愈了心律失常。我们还寻找了将 SVT 误诊为 VT 的原因。结果发现，电击是由于符合 2/3 标准（突发和规律性心动过速）。因此，尽管适当的形态匹配有利于 SVT，他还是接受了治疗。这是 ICD 众所周知的局限性之一，常规 SVT（AVNRT/AVRT 或 AT）可能会接受不适当的 ICD 治疗。经过慢速通路改造后，SVT 或 VT 均未再复发；因此，底物改造被推迟。

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引用次数: 0