起搏器主动固定电极植入术中损伤电流测定的应用  

Application of determination on injury current in the cardiac pacing with active-fixation lead

作　　者：汤永谦[1] 廖乐琴[1] 刘海[1] 丁星华[1] 任勇[1] 赵惠[1] 刘文卫[1] 

机构地区：[1]襄阳市中心医院心内科,湖北襄阳441021

出　　处：《临床心血管病杂志》2014年第11期947-949,共3页Journal of Clinical Cardiology

摘　　要：目的：探讨右心室流出道间隔部主动固定电极植入术中,测定心腔内损伤电流的意义。方法：2011-01-2013-12,106例永久性起搏器植入的患者,应用了右心室流出道间隔部主动固定电极,对于电极的可靠固定,除了结合体表心电图和X线影像,常规测试起搏阈值、R波振幅、电极阻抗外,使用了美敦力公司2290型起搏器分析仪,测定心腔内损伤电流的大小,进一步确定电极固定的可靠性。结果：99例患者均顺利完成手术,术后第1~7d、第1、3、6个月,对电极的阈值、电极阻抗、R波振幅、QRS波时限进行评估,必要时进行心脏超声和X线拍片检查,无一例电极脱位。7例患者右心室流出道间隔部主动固定电极植入未能完成,被迫改为心尖部起搏。结论：对于右心室流出道间隔部主动固定电极植入的定位,除采用传统的起搏参数、起搏心电图和X线影像学方法外,结合术中损伤电流的测定更加可靠。Objective：To explore the clinical value of injury current in right ventricular septum pacing with active-fixation lead.Method：From January 2011 to December 2013,106 patients implanted the right ventricular septum pacing with active-fixation lead.In order to confirm the lead was reliable fixed,we used ECG,X-ray image and the test results of pacing threshold,R-wave amplitude,electrode impedance,otherwise,We used a Medtronic Inc 2290 pacemaker analyzer to determine the size of the current intracardiac injury.Result：The 99 patients have the successfully operation and no dislocation of electrode.After the first 1-7days,first,3,6months,we assessed the threshold of electrode,electrode impedance,R-wave amplitude,QRS-wave duration,when necessary,cardiac ultrasound and X-ray examination were involved.The 7patients failed to have the right ventricular septum pacing with active-fixation lead,then we changed the electrode position to the Right ventricular apex.Conclusion：They are more reliable combined with injury current measurement,except conventional pacing parameters,pacing ECG and radiographic methods,in the positioning of right ventricular outflow tract septum pacing with active-fixation lead.

关 键 词：主动固定电极 损伤电流 右心室流出道 心脏起搏 腔内心电图 

分 类 号：R541.7[医药卫生—心血管疾病]