{"id":156,"date":"2025-07-09T09:53:36","date_gmt":"2025-07-09T09:53:36","guid":{"rendered":"https:\/\/cardiocases.com\/?page_id=156"},"modified":"2025-10-07T13:29:25","modified_gmt":"2025-10-07T13:29:25","slug":"first-shock-in-vt-zone","status":"publish","type":"page","link":"https:\/\/cardiocases.com\/fr\/pacing-defibrillation\/basic-concepts\/icd\/first-shock-in-vt-zone\/","title":{"rendered":"Amplitude premier choc zone de TV"},"content":{"rendered":"<div data-elementor-type=\"wp-page\" data-elementor-id=\"156\" class=\"elementor elementor-156\" data-elementor-post-type=\"page\">\n\t\t\t\t<div class=\"elementor-element elementor-element-5f6ef45 e-con-full e-flex e-con e-parent\" data-id=\"5f6ef45\" data-element_type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t<div class=\"elementor-element elementor-element-e2c4ddc elementor-widget elementor-widget-heading\" data-id=\"e2c4ddc\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Amplitude premier choc zone de TV<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-d7b0212 e-con-full e-flex e-con e-parent\" data-id=\"d7b0212\" data-element_type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t<div class=\"elementor-element elementor-element-4b0fbe7 elementor-widget elementor-widget-text-editor\" data-id=\"4b0fbe7\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<p style=\"color: rgb(0, 0, 0);\">Dans une zone de TV &gt; 140 battements\/minute, des chocs sont habituellement programm\u00e9s si les s\u00e9quences de stimulation anti-tachycardique sont inefficaces. L'amplitude du premier choc peut \u00eatre programm\u00e9e 1) soit \u00e0 faible amplitude (choc de cardioversion de 5 \u00e0 10 Joules) 2) soit aux capacit\u00e9s maximales de l'appareil pour optimiser les chances d'efficacit\u00e9 d'un choc unique. L'amplitude des chocs suivants est g\u00e9n\u00e9ralement maximale.<\/p><p style=\"color: rgb(0, 0, 0);\">Les avantages de programmer un premier choc de faible amplitude (5 \u00e0 10 Joules) sont: 1) de r\u00e9duire la consommation et ainsi d'\u00e9pargner l'usure de la batterie ce qui est particuli\u00e8rement important quand le nombre d'\u00e9pisodes de TV  n\u00e9cessitant un choc est \u00e9lev\u00e9 2) de limiter le temps de charge: ce param\u00e8tre semble peu d\u00e9terminant dans la mesure o\u00f9 le choc en zone de TV ne survient g\u00e9n\u00e9ralement qu'une minute apr\u00e8s le d\u00e9but de l'\u00e9pisode (d\u00e9lai pour les diff\u00e9rentes s\u00e9quences de stimulation anti-tachycardique) et les quelques secondes de diff\u00e9rence dans le temps de charge influent peu sur la tol\u00e9rance de l'\u00e9pisode 3) l'effet d\u00e9l\u00e9t\u00e8re des chocs \u00e9lectriques a \u00e9t\u00e9 clairement d\u00e9montr\u00e9 avec un impact n\u00e9gatif sur la morbi-mortalit\u00e9 des patients (par probable l\u00e9sion myocardique directe induite par les chocs); r\u00e9duire l'amplitude des chocs pourrait donc \u00e9galement r\u00e9duire les l\u00e9sions myocardiques g\u00e9n\u00e9r\u00e9es et ainsi r\u00e9duire les effets d\u00e9l\u00e9t\u00e8res.<\/p><p style=\"color: rgb(0, 0, 0);\">A l'oppos\u00e9, les avantages d'un premier choc d'amplitude maximale sont: 1) d'augmenter la probabilit\u00e9 de r\u00e9duire la TV d\u00e8s la premi\u00e8re tentative et ainsi de r\u00e9duire le nombre de chocs n\u00e9cessaires 2) si l'amplitude du choc est au-dessus de la limite sup\u00e9rieure de vuln\u00e9rabilit\u00e9 atriale et ventriculaire, le risque d'induction de FA ou de FV (cas d\u00e9crits de troubles du rythmes ventriculaires polymorphes tr\u00e8s rapides induits par un choc de faible amplitude) est moindre 3) d'augmenter les chances de r\u00e9duction d'une FA, si le choc est inappropri\u00e9 et ainsi de r\u00e9duire le nombre de chocs d\u00e9livr\u00e9s.<\/p><p style=\"color: rgb(0, 0, 0);\">&nbsp;La question de la douleur occasionn\u00e9e par un choc \u00e9lectique en fonction de son amplitude reste d\u00e9battue. Il parait intuitif de penser qu'un choc de faible amplitude puisse r\u00e9duire la douleur associ\u00e9e. Les travaux sur les d\u00e9fibrillateurs atriaux (multiples chocs de petite amplitude) ont cependant montr\u00e9 que 1) la relation entre amplitude du choc et douleur occasionn\u00e9e n'est pas lin\u00e9aire 2) le deuxi\u00e8me choc d'un m\u00eame \u00e9pisode est toujours plus douloureux (physiquement et psychologiquement) que le premier (contraction musculaire importante \u00e0 la suite du premier choc). La priorit\u00e9 de la programmation dans ce cadre serait alors de r\u00e9duire autant que possible le nombre de chocs d\u00e9livr\u00e9s en favorisant un premier choc d'amplitude maximale.&nbsp;<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>","protected":false},"excerpt":{"rendered":"<p>First shock in VT zone In a VT zone &gt;140 bpm, shocks are often programmed in case of unsuccessful ATP. The first shock can be programmed as 1) a 5 to 10 J cardioversion or 2) a maximal output cardioversion to maximize the likelihood of success of a single shock. The davantages of programming a [&hellip;]<\/p>","protected":false},"author":1,"featured_media":0,"parent":19,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"footnotes":""},"class_list":["post-156","page","type-page","status-publish","hentry"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v26.8 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>ICD First Shock in VT Zone | Programming | Cardiocases<\/title>\n<meta name=\"description\" content=\"ICD first shock therapy in VT zone \u2014 energy selection, shock delivery &amp; ECG tracings. 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