永久起搏器单双极导线工作性能比较  

Long-term comparison of electrophysiolagical characteristics of bipolar and unipolar leads

作　　者：刘菁晶[1] 林文华[1] 张峰[1] 王晓冬[1] 安立敏[1] 司海龙[1] 史宏岩[1] 宋振国[1] 敬锐[1] 王志坚[1] 任自文[1] 

机构地区：[1]天津医科大学心血管病临床学院、泰达国际心血管病医院内一科,天津300457

出　　处：《临床心血管病杂志》2009年第7期516-519,共4页Journal of Clinical Cardiology

摘　　要：目的:观察单、双极导线于起搏器置入术中及术后起搏阈值、感知、阻抗的变化规律并比较其差异。方法:对2005-07-2008-04间所有置入双极导线可程控极性起搏器的患者共208例(男101例,女107例,平均年龄63岁)随访1年,分别在置入时、术后1周、1个月、3个月、6个月及1年测试单、双极起搏阈值、阻抗以及P/R振幅,比较同一时间不同极性间各项指标的差异以及同一极性不同时间各项指标的变化情况。结果:无论心房还是心室导线,术中双极起搏能量及电压阈值均显著低于单极(P<0.01)。术后1周以及长期随访时二者能量阈值无显著性差异,单极起搏电压阈值低于双极(P<0.01)。从术后1周开始,心房和心室双极电压及能量阈值均有升高趋势,心室单极电压及能量阈值有升高趋势。心房单极电压及能量阈值自术后1周开始下降,术后12个月仍低于术中水平。无论心房还是心室导线,双极阻抗于术中及术后任何时间均高于单极(P<0.01),双极P/R振幅于术中及术后任何时间均高于单极(P<0.01)。结论:无论心房还是心室导线,术中以及术后起搏压阈值、阻抗以及P/R振幅在单、双极状态下均明显不同,而起搏能量阈值在术中单极高于双极,术后二者无差别。Objective：To compare the pacing thresholds, impedance and P/R wave＇amplitude between unipolar and bipolar pacemaker systems in atrium and ventricles during implantation and follow-up period. Methods： Pacing thresholds, impedance and P/R wave amplitude were measured respectively during implantation and one week, 1, 3, 6, 12 months after implantation in 208 patients（101 male,107 female;mean age of 63 years） with a unipolar/bipolar multiprogrammable pacemaker. The measurements were compared between different polar leads in the same time, and between the different time in the same polar leads. Results：During implantation, the bipolar voltage and energy thresholds in both atrium and ventricle were lower than unipolar mode （P〈0.01）. However, since one week after implantation and long-term follow-up, the energy threshold was no different between unipolar and bipolar mode, the unipolar voltage threshold was lower than bipolar mode （P〈0.01）. The bipolar voltage and energy pacing thresholds gradually increased both in atrium and in ventricular, unipolar voltage and energy pacing threshold in ventricular had the same change. Unipolar voltage and energy pacing thresholds in atrium began to decrease, and 12 months later still lower than the level during implantation. Both in the atruim and ventricle, bipolar impedance was higher than unipolar mode during implantation and follow up period（P〈0.01）. Bipolar P/R wave amplitude was higher than unipolar mode at implantation and during follow-up period（P〈0.01）. Conclusion： The pacing voltage thresholds, impedance and P/R wave amplitude were significant different between the unipolar and bipolar mode during implantation and follow-up period both in atruim and ventricle. The unipolar energy pacing threshold was higher than bipolar at implantation. However, there was no significant different between them during followup period.

关 键 词：心律失常 心脏起搏 人工 阻抗 感知器 

分 类 号：R541.7[医药卫生—心血管疾病]