Case Reports Korean Circulation J 1999;29 10 : 제세동역치가높았던특발성심실세동에시술한 삽입형심실제세동기 ICD 1 예 송창석 김형주 박현용 박희백 장영광 차태준 주승재 이재우 Implantation of ICD in

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1 Case Reports Korean Circulation J 1999;2910: 제세동역치가높았던특발성심실세동에시술한 삽입형심실제세동기 ICD 1 예 송창석 김형주 박현용 박희백 장영광 차태준 주승재 이재우 Implantation of ICD in a Ventricular Fibrillation Patient with a High Defibrillation Threshold Chang-Suk Song, MD, Hyung-Joo Kim, MD, Hyun-Yong Park, MD, Hee-Bag Park, MD, Young-Kwang Jang, MD, Tae-Joon Cha, MD, Seong-Jae Joo, MD and Jae-Woo Lee, MD Department of Internal Medicine, Kosin Medical College, Pusan, Korea ABSTRACT ICD implantable cardioverter-defibrillator has been recently accepted as the most effective treatment for patients with medically refractory or life threatening ventricular tachycardia or ventricular fibrillation. Determination of the DFT defibrillation threshold is important in the implantation of ICD. DFT is the lowest shock energy that successfully terminates ventricular fibrillation. Preoperative amiodarone use, increased body size, and left ventricular dilatation are associated with high DFT. Recently, we experienced a 66 year-old male patient presenting with syncope due to idiopathic ventricular fibrillation in whom DFT was high and unstable, probably due to preoperative use of amiodarone. Korean Circulation J 1999;2910: KEY WORDSICD implantable cardioverter defibrillator DFT defibrillation threshold. 서 론 1138

2 증례 Fig. 1. Resting electrocardiogram in the patient. 1139

3 Fig. 2. Ventricular fibrillation recorded during Holter monitoring. 240/220 ms)을 주었을 때 빠른 심실빈맥이 발생하면 eter)는 R wave 14.6 mv, threshold 0.6 V(0.05 서 바로 심실세동으로 진행되는 것을 확인할 수 있었다. msec), 저항(impedance)은 754Ω이었다. 제세동역치 시술 및 경과 내원 당시 심전도를 감시하면서 3일간 검사는 T wave shock으로 심실세동을 유발시킨 후 실 amiodarone loading(200 mg tid)을 실시하였으나 DFT 시하였으며 유발된 심실세동은 처음에 15 J로 성공적 가 올라갈 것을 염려하여 투약을 중단하였다. 입원 12 으로 제세동이 되었으나 반복하여 실시한 제세동에서 일째 국소 마취하에 좌측 쇄골하방에 피부절개를 하고 15 J로 제세동이 되지 않아 20 J로 다시 제세동을 시 좌측 쇄골하정맥 천자(left subclavian vein puncture) 도하였으나 실패하였다. 제세동유도의 극성을 바꾼 후 를 실시하였으며 피하조직을 박리하여 ICD를 삽입하였 20 J로 제세동에 성공할 수 있었고 한번 더 20 J에 성 고 전극유도는 우심실첨부에 위치시켰다. 공적으로 제세동이 되었다(Fig. 3). 심실 제세동역치검 측정된 자극 및 감지지표(pace and sensing param 사 도중 혈압저하나 호흡부전 등은 발생하지 않았다 Korean Circulation J 1999;29(10):

4 Fig. 3. Successful defibrillation with 20 J of reverse polarity. Table 1. Result of defibrillation threshold (DFT) test Test Therapy Pre-therapy rhythm Polarity Wave Energy Ohms Comments 1 0 sinus Ax B Monophasic 0.2 J 77 HV lead impedance test 2 1 VF Ax B Biphasic 14 J 61 Successful Charge time3.48 sec 3 1 VF Ax B Biphasic 15 J Unsuccessful 1 VF Biphasic 29.4 J Successful Ax B 56 Charge time8.43 sec 4 1 VF Ax B Biphasic 20 J Unsuccessful 1 VF Ax B Biphasic 30 J Successful 5 1 VF B Ax Biphasic 19.5 J 57 Successful Charge time5.07 sec 6 1 VF B Ax Biphasic 19.5J 57 Successful Charge time5.14 sec 7 1 VF B Ax Biphasic 20 J 62 Successful Charge time3.84sec Fig. 4. Successful defibrillation of spontaneous ventricular fibrillation 17 days after the implantation of an ICD. 고안 1141

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6 중심단어 REFERENCES 1) Mirowski M, Mower MM, Staewen WS, Tabatznik B, Mendeloff A. Standby automatic defibrillator: An approach to prevention of sudden coronary death. Arch Intern Med ) Mirowski M, Reid PR, Mower MM, Watkins L, Gott VL, Schauble JF, et al. Termination of malignant ventricular arrhythmias with an implanted automatic defibrillator in human being. N Engl J Med ) Trappe HJ. TheModernImplantable Cardioverter-Defibrilla-tor Comparing It to Those of the Late 1980s. Am J Cardiol A3-8. 4) Link MS, Costeas XF, Griffith JL, Colburn CD, Mark E NA, Wang PJ. High incidence of appropriate Implantable Cardioverter-Defibrillator therapy in patients with syncope of unknown etiology and inducible ventricular arrhythmias. Am J Coll Cardiol ) Aronow WS. Treatment of ventricular arrhythmias in older adults. J Am Geriatr Soc ) Klein H, Auricchio A, Huvelle E, Nisam S. Initial clinical experience with a new down-sized Implantable Cardioverter-Defibrillator. Am J Cardiol A ) Kennergren C. Impact of implant techniques on Complications with current Implantable Cardioverter-Defibrillator systems. Am J Cardiol ) Wyse DG, Kavanagh KM, Gillis AN, Mitchell LB, Buff HJ, Sheldon RS, et al. Comparison of biphasic and monophasic shocks for defibrillation using a nonthoracotomy system. Am J Cardiol ) Jordaens L, Vertongen P, Provenier F, Trouerbach JW, Poelaert J, Herregods L. A new transvenous internal cardioverter-defibrillator Implantation technique, complications, and short-term follow-up. Am Heart J ) Porterfield JG, Porterfield LM, Levine JH, Luceri RM, Hsia MM. Compatibility of a nonthoracotomy lead system with a biphasic implantable cardioverter-defibrillator. Am J Cardiol ) Khalighi K, Daly B, Leino EV, Shorofsky SR, Kavesh NG, Peter RW, et al. Clinical predictors of transvenous defibrillation energy requirement. Am J Cardiol ) Anderson JL, Karagounis LA, Roskelly M, Osborn JS, Horndraham D. Effect of prophylactic antiarrhythmic therapy on time to implantable cardioverter-defibrillator discharge in patient with ventricular tachyarrhythmia. Am J Cardiol ) Brooks R, Garan H, Torchiana D, Vahakes GJ, Jackson G, Newell J, et al. Determinants of successful nonthoracotomy cardioverter-defibrillator implantation: Experience in 101 patients using two different lead systems. J Am Coll Cardiol

Case Reports Korean Circulation J 2000;30 11 : 심근경색후재발하는심실세동환자에서 삽입형심실제세동기치료 1 예 문원 1 김준수 1 허상택 1 이상 1 이성윤 1 권현철 1 박승우 1 김덕경 1 이상훈 1 홍경표 1 박정

Case Reports Korean Circulation J 2000;3011:1442-1447 심근경색후재발하는심실세동환자에서 삽입형심실제세동기치료 1 예 문원 1 김준수 1 허상택 1 이상 1 이성윤 1 권현철 1 박승우 1 김덕경 1 이상훈 1 홍경표 1 박정의 1 서정돈 1 이원로 1 최윤정 2 조현성 2 정익수 2 Implantable Cardioverter-DefibrillatorICD