Case Reports Korean Circulation J 1999;2910:1138-1143 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;2910:1138-1143 KEY WORDSICD implantable cardioverter defibrillator DFT defibrillation threshold. 서 론 1138
증례 Fig. 1. Resting electrocardiogram in the patient. 1139
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- 1140 사 도중 혈압저하나 호흡부전 등은 발생하지 않았다 Korean Circulation J 1999;29(10):1138-1143
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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