新型主动固定起搏导线的临床应用  

The clinical application of new active-fixation pacing lead

作　　者：陈继升 汪一波 沈法荣 凌锋[1] 陈建明[1] 孙国建[1] 何浪[1] 

机构地区：[1]浙江医院心内科,杭州市310013 [2]临安市人民医院心内科 [3]浙江绿城心血管病医院

出　　处：《心电与循环》2014年第1期35-38,49,共5页Journal of Electrocardiology and Circulation

摘　　要：目的评估植入新型主动固定起搏导线的可用性和安全性。方法选择本中心植入永久性人工心脏起搏器患者101例,分为新型导线组(n=25)和传统导线组(n=76),新型导线组患者植入Medtronic 3830导线3根,5086MRI导线14根(包括心房、心室导线),Boston Scientific4471导线15根;传统导线组患者植入心室主动固定导线76根,心房被动固定导线58根,测量植入后各相关起搏参数,手术时间,曝光时间及心室导线过三尖瓣的次数,并常规随访。结果两组导线的阈值[(0.62±0.14)V、(0.63±0.17)V]、振幅[(1 1.29±4.28)mV、(12174±6.08)mV]、阻抗[(767.68±132.73)Ω、(815.14±182.46)Ω]、电流[(0177±0.19)mA、(0.85±0.33)mA]、斜率(2.46±1.07、2.84±1.02)差异均无统计学意义(均P≥0.05),两组起搏导线损伤电流[(6.83±1.57)mV、(6.61±1.87)mV]、植入手术时间[(44.20±4.65)min、(43.42±5.55)min]、曝光时间[(3.24±1.04)min、(3.33±1.05)min]、导线过三尖瓣次数(1.36±0.57、1.34±0.63)差异均无统计学意义(均P>0.05)。三种新型起搏导线植入时均未发生并发症,4471导线出现1例术后完全脱位。1年时随访两组导线的阈值、振幅、阻抗异均无统计学意义(均P>0.05)。结论新型起搏导线均符合起搏器植入要求,未增加手术时间和曝光时间,植入安全。Objective To evaluate availability and safety of new active-fixation pacing lead. Methods 101 patients underwent pacemaker implantation at our heart center, of them, 25 cases received new pacing lead （new lead group）, including 3 Medtronic 3830 leads, 14 5086MRI leads （atrial and ventricular leads） and 15 Boston Scientific 4471 leads, the others received 76 ventricular active-fixation leads and 58 atrial passive leads （traditional group）. Pacing parameters, operation time, duration of exposure, and the time for lead passing through the tricuspid orifice were recorded. Results The pacing threshold, amplitude, impedance, current, and slope were not significant difference between two groups [ （0.62 ± 0.14） vs （0.63 ± 0.17）V, （11.29 ± 4.28） vs （12.74 ± 6.08）mV, （767.68 ± 132.73） vs （815.14 ± 182.46）Ω, （0.77 ± 0.19） vs （0.85 ± 0.33）mA, （2.46 ± 1.07） vs （2.84 ± 1.02）, respectively]. The injury current, operative time, exposure time[（3.24 ± 1.04） vs （3.33 ± 1.05）min], and the time for lead passing through the tricuspid orifice （1.36 ± 0.57 vs 1.34 ± 0.63）were similar in two groups [（6.83 ± 1.57） vs （6.61 ± 1.87）mV, （44.20 ± 4.65） vs （43.42 ± 5.55）min, （3.24 ± 1.04） vs （3.33 ± 1.05） min, 1.36 ± 0.57vsi.34 ± 0.63, respectively]. There was no serious complication during implantation of new pacing lead. A 4471 model lead dislocated completely after operation. There was no significant difference of threshold, amplitude and impedance between two groups at 1-year follow-up （all P 〉0.05）. Conclusion The new pacing leads are safety and meet the requirements of pacemaker implantation, without increasing the operative time and exposure time.

关 键 词：主动固定导线 阈值 P R振幅 阻抗 损伤电流 

分 类 号：R541.7[医药卫生—心血管疾病]