真实世界中双心室再同步起搏器的寿命分析  

Bi-ventricular Resynchronization Pacemaker Longevity Information in Real World

作　　者：牛红霞[1] 华伟[1] 王靖[1] 丁立刚[1] 刘志敏[1] 陈柯萍[1] 王方正[1] 张澍[1] 

机构地区：[1]中国医学科学院北京协和医学院心血管病研究所阜外心血管病医院心律失常诊治中心,北京市100037

出　　处：《中国循环杂志》2014年第5期356-359,共4页Chinese Circulation Journal

基　　金：慢性心力衰竭的心脏再同步治疗中国医药卫生事业发展基金资助项目(2011-H26);慢性心力衰竭患者心脏性猝死的一级预防十二五国家科技支撑计划资助项目(2011BAI11B11)

摘　　要：目的：评估双心室再同步起搏器在真实世界中的使用寿命。方法：人选在阜外心血管病医院因电池原因成功施行心脏再同步治疗（cardiac resynchronization therapy，CRT）更换的病例，调阅更换术前程控报告，分析更换术前电池状态、右／左心室电极导线的输出电压和脉宽等。电池状态分为已达电池更换指标（elective replacement indicator，ERI）和电量下降。已达ERI者，电池实际寿命为植入至实际达ERI的时间间隔；电量下降者，电池实际寿命为植入至提示电量下降的时间间隔与预期使用寿命之和。结果：1999—08至2013—09阜外心血管病医院共成功施行CRT更换11例。男性6例，女性5例，首次植入时平均年龄（61．9±9．7）岁。11台被更换CRT的体内埋置时间平均（5．8±1．6）年（2．6～7．7年），CRT实际寿命平均（5．8±1．4）年（3-7．8年）。更换原因包括5例（45．5％）已达ERI，6例（54．5％）为电池电量下降。使用寿命长于4年者共9例，占81．8％。使用寿命不足质保4年者仅2例（18．2％），其左心室输出能量为4．0V／1．0ms和5．0V／L0ms。右心室输出设置平均（3．1±0．9）V／0．4ms（2．0～5．0V／0．4ms），左心室输出电压设置平均（4．6±0．6）V（3．5～5．0V），脉宽平均（0．5±0．2）ms（0．4-1．0ms）。结论：在体双心室再同步起搏器的平均使用寿命为5．8年，其中使用寿命长于4年者占80％。Objective： To evaluate the accurate information of biventricular pacemaker longevity for patients with cardiac resynchronization therapy （CRT） in real world clinical practice. Methods： A total of 11 patients with successful CRT replacement in our hospital from 1999-08 to 2013-09 were enrolled. There were 6 male and 5 female patients with the mean age of （61.9±9.7） years. The device recorded data at the last interrogation including battery status and output voltage, pulse width in right and left ventricles were analyzed. The battery status was categorized into 2 conditions as reaching the elective replacement indicator （ERI） and low battery voltage. For ERI condition, the device longevity was the interval between original implantation and the time of reaching ERh For low battery voltage condition, the longevity was the sum of remaining lifespan and the time from original device implantation to the last interrogation. Results： The average age for the first implantation was at （61.9±9.7） years and the mean time from original implantation to replacement was from 2.6 to 7.7 （5.8±1.6） years. The real CRT device lifespan was from 3 to 7.8 （5.8±1.4） years. There were 5 （45.5%） patients reaching ER1 condition and 6 （54.5%） at low battery voltage condition. There were 9 （81.8%） patients with CRT device longevity longer than 4 years and 2 （18.2%） less than 4 years which had left ventricular output 4.0V/1.0 ms and 5.0V/1.0 ms. The mean right ventricular lead output was （2.0± 5.0）V/0.4 ms, （3.1±0.9）V/0.4 ms, the mean left ventricular lead output was （3.5-5.0）V/0.4 ms, （4.6±0.6）V/0.4 ms. The mean pulse width was （0.4-1.0） ms, （0.5±0.2） ms. Conclusion： The real world longevity of CRT device was 5.8 years and 80% of them had the lifespan longer than 4 years.

关 键 词：心脏再同步治疗 双心室 起搏器 寿命 输出 

分 类 号：R54[医药卫生—心血管疾病]