改良起搏电极塑型行右室流出道主动固定的临床应用  

Clinical applications of active fixation at the right ventricular outflow tract using a modified pacing leads model

作　　者：曾智桓[1] 陈泗林[2] 赵艳群[1] 周万兴[1] 张卫[1] 朱桂平[1] 李博维[1] 周玉良[1] 

机构地区：[1]广东药学院附属第一医院心内科,广东广州510080 [2]广东省人民医院心内科,广东广州510080

出　　处：《南方医科大学学报》2014年第7期1020-1024,共5页Journal of Southern Medical University

基　　金：广东省科技基金(2011B061300072)

摘　　要：目的探讨改良主动固定起搏电极导线塑型行右室流出道间隔部起搏的可行性与安全性。方法 136例需要植入人工心脏起搏器,且需要植入心室主动固定起搏电极导线的患者,随机分为两组,传统电极塑型组(CRVOTP)将电极导线内芯钢丝塑型为双弯三维形状进行右室流出道间隔部电极固定;改良电极塑型组(MRVOTP)将电极导线内芯钢丝塑型为J弯进行右室流出道间隔部电极固定。结果两组均100%成功行右室流出道间隔部起搏,无严重并发症,术中电极固定次数、起搏阈值、阻抗、R波高度及QRS波宽度比较,两组间均无显著统计学差异。由于MRVOTP组塑型简单,容易通过三尖瓣环及直接到达右室流出道间隔部,X线曝光、植入时间较CRVOTP组明显缩短,有显著统计学意义(P<0.05),并较少损伤起搏电极导线。术后随访,无一例发生主动固定起搏电极导线脱位,复测心室电极起搏阈值、阻抗、R波高度及QRS波宽度,两组间均无显著统计学差异。结论改良主动固定起搏电极导线塑型行右室流出道间隔部起搏,方法简单,安全可靠,较传统电极塑型右室流出道间隔部起搏显著减少X线曝光、植入时间,较少损伤起搏电极导线。Objective To assess the feasibility and safety of using the modified active fixation pacing leads model to pace the right ventricular outflow tract septum. Methods A total of 136 patients undergoing artificial heart pacemaker implantation with active fixation pacing leads were randomized into two groups to receive conventional right ventricular outflow tract pacing （CRVOTP） or modified right ventricular outflow tract pacing （MRVOTP）. The electrode lead wire core was modeled in a double-curved three-dimensional shape in CRVOTP group and in a J-shaped bend in MRVOTP group before fixation at the right ventricular outflow tract septum. Results Right ventricular outflow tract septum pacing was achieved successfully in all the patients. None of patients experienced serious complications. No significant differences were found between the two groups in the number of times of electrode fixation, pacing thresholds, impedance, R wave height or QRS wave width during the operation, but MRVOTP was associated with a reduced time of X-ray exposure and operation （P〈0.05） due to the convenience in electrode modeling and in passing the leads through the tricuspid annulus and the direct access to the right ventricular outflow tract septum. Postoperative follow-up of the patients showed no incidence of active fixation pacing lead dislocation and comparable pacing thresholds of the ventricular electrodes, impedance, R wave height and QRS wave width between the two groups. Conclusion Using the modified active fixation pacing leads model to pace the right ventricular outflow tract septum can reduce the time of X-ray exposure and operation with a low probability of lead damage.

关 键 词：心脏起搏器 右室流出道起搏 主动固定电极 安全性 

分 类 号：R541.7[医药卫生—心血管疾病]