损伤电流的动态变化与主动固定起搏电极稳定性的关系  

Dynamic changes in current of injury predicts adequate active lead fixation in permanent pacemaker leads

作　　者：陈建华[1] 张飞龙[1] 陈学海[1] 王伟伟[1] 傅发源[1] 陈良龙[1] 

机构地区：[1]福建医科大学附属协和医院心内科福建省冠心病研究所,福州350001

出　　处：《临床心血管病杂志》2013年第11期819-823,共5页Journal of Clinical Cardiology

摘　　要：目的:评价损伤电流(COI)的动态变化与主动固定起搏电极稳定性之间的关系。方法:采用队列研究设计,将138例符合纳入标准的行永久心脏起搏器植入治疗的患者分成两组。A组,90例,起搏导线螺旋固定10min后测得的COI10>3.5mV;B组,48例,COI10值<3.5mV。比较两组COI0(起搏导线螺旋固定后即刻测得COI)值和COI10值的变化,观察起搏导线螺旋固定10min后起搏阈值和R波感知的变化。结果:A组与B组比较:①COI0值为(10.54±1.98)mV∶(6.54±0.81)mV(P<0.001),COI10值为(6.84±1.70)mV∶(2.47±0.53)mV(P<0.001),导线螺旋固定10 min后测试结果:起搏阈值(0.61±0.18)V∶(1.40±0.31)V(P<0.001),R波感知(15.40±4.18)mV∶(5.10±0.77)mV(P<0.001),电极阻抗(716.47±150.03)ohms∶(745.00±149.93)ohms,P=0.479。②B组中有9例患者于术中稍用力向后提拉导线后发生起搏导线脱位;15例患者10min后测得的起搏阈值和(或)R波感知不良而进行重新植入;有2例患者10min后测得的起搏参数均满意,但分别于术后10h和24h发生起搏导线脱位,予重新植入。而A组患者术中提拉导线均未发生导线脱位,10min测得的起搏参数均满意。术后3个月随访,两组患者右心室电极起搏阈值、R波感知以及电极阻抗等参数均在正常范围,两组比较各参数P>0.05。结论:起搏导线螺旋固定后即刻测得的COI0值较低(<7.0mV),COI值迅速下降,COI10值<3.0mV,导线螺旋固定10min后测得的起搏阈值无明显降低,R波感知降低,提示起搏导线固定不良,容易造成起搏导线脱位,需要寻找新的位置进行重新植入。Objective：To determine whether dynamic changes in current of injury（COI）can guide adequate placement of active-fixation pacing leads.Method：A cohort study was conducted among 138patients underwent permanent pacemaker implantation.According to the current of injury measured 10minutes after the leads fixation（COI10）,patients were divided into two group,group A（COI103.5mV,n=90）and group B（COI103.5mV,n=48）.Compared with the changes of COI0（Current of injury measured 0 minutes after the leads fixation）and COI10 in group A and B,We observe Current of injury was characterized as the magnitude of ST-segment elevation.Pacing parameters were measured up to 10 min after fixation.Result：Compared with group A and B,①the current of injury measured right after the leads fixation（COI0）was significantly higher[（10.54±1.98）mV vs（6.54±0.81）mV,P0.001],COI10was also significantly higher[（6.84±1.70）mV vs（2.47±0.53）mV,P0.001].Pacing threshold was significantly lower[（0.61±0.18）V vs（1.40±0.31）V,P0.001].R-wave sensing amplitude was significantly higher[（15.40±4.18）mV vs（5.10±0.77）mV,P0.001].Pacing impedance was no different[（716.47±150.03）ohms vs（745.00±149.93）ohms,P=0.479].②In group B,9 leads dislodged after withdrawn slightly,15 leads had relatively high pacing threshold and/or low R-wave sensing amplitude which needed repositioning,2 leads dislodged at 10 and 24 hours respectively after implantation,despite the pacing threshold and sensing amplitude were normal measured 10 minutes after the lead fixation.While there was no lead dislodging in group A.Conclusion：After active lead fixation,the COI0 is lower（7.0mV）.Then the COI falls down rapidly,and the COI 10 is lower than 3.0mV.Pacing threshold is no significantly lower,and the Rwave sensing is significantly higher than that before active lead fixation.The lead fixation is not adequate and the lead should be repositioned.

关 键 词：心律失常 损伤电流 起搏 

分 类 号：R541.7[医药卫生—心血管疾病]