心房螺旋电极导线植入术后起搏阈值的急性改变  

Acute change in pacing threshold after implantation of atrial active fixation lead

作　　者：高洁[1] 王晓群[1] 李畅[1] 王义龙[1] 倪熠[1] 顾刚[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院心血管内科,上海200025

出　　处：《内科理论与实践》2017年第1期50-53,共4页Journal of Internal Medicine Concepts & Practice

摘　　要：目的:探讨心房螺旋电极导线植入术后起搏阈值的急性变化,用以评价心房螺旋电极导线植入是否有效、安全。方法:收集2015年11月至2016年6月期间在我院植入埋藏式人工心脏双腔起搏器、且心房植入螺旋电极导线的患者68例,根据患者植入术中即刻起搏阈值是否>1 V分为高阈值组和低阈值组2组,记录患者在植入术中即刻,术后1、3、6、24 h的起搏参数变化及并发症等情况。结果:68例患者中术中即刻起搏阈值≤1 V的低阈值组患者35例(51%),平均起搏阈值为(0.79±0.20)V,术后1 h下降为(0.69±0.34)V、3 h(0.61±0.21)V、6 h(0.59±0.19)V、24 h(0.58±0.18)V,术后3、6、24 h的起搏阈值与术中即刻相比,差异具有统计学意义(均P<0.01)。术中即刻起搏阈值>1 V的高阈值组患者33例(49%),其平均起搏阈值为(1.48±0.20)V,术后1 h下降为(0.85±0.32)V、3 h(0.74±0.23)V、6 h(0.64±0.18)V、24 h(0.60±0.24)V,术后1、3、6、24 h的起搏阈值与术中即刻相比,差异均具有统计学意义(均P<0.01)。术后除3 h外,其余各时间点间2组间起搏阈值差异均无统计学意义(均P>0.05)。结论 :心房螺旋电极导线植入术中即刻起搏阈值较高,术后降低。植入术中即刻起搏阈值高不应作为更换电极位置的标准。Objective To study the acute change in pacing threshold after implantation of atrial active fixation lead to evaluate whether the implantation of active fixation lead is safe and effective. Methods Sixty-eight patients who were implanted with atrial active fixation lead for new pacemaker implantation from November 2015 to June 2016 were enrolled. The patients were divided into high threshold group （〉1 V） and low threshold group （≤ 1 V） based on the initial pacing threshold at implantation. Pacing thresholds were collected just during the operation, and 1, 3, 6 and 24 h after operation. Results Among the 68 patients, initial pacing threshold at implantation ≤ 1 V [mean （0.79±0.20） V] was demonstrated in 35（51%） leads, and falling to （0.69±0.34） V just 1 h after operation, to （0.61±0.21） V 3 h after operation, to （0.59±0.19） V 6 h after operation, and to （0.58±0.18） V 24 h after operation, thresholds 3, 6 and 24 h after operation were significantly lower than threshold at implantation （all P〈0.01）. Initial pacing threshold at implantation 〉1 V [mean （1.48±0.20） V] was demon- strated in 33 （49%） leads, and falling to （0.85±0.32） V just 1 h after operation, to （0.74±0.23） V 3 h after operation, to （0.64±0.18） V 6 h after operation and to （0.60±0.24） V 24 h after ope,＇ation, the difference in threshold at implantation with that at 1, 3, 6, and 24 h after operation was statistically significant （all P〈0.01）. Except for 3 h after operation, the difference in pacing threshold between the two groups was not statistically significant （all P〉0.05）. Conclusions Atrial ac- tive fixation lead is commonly associated with an initially high pacing thresholds that will fall rapidly after operation. The majority will have a threshold 〈1 V on the following day. The initial high pacing threshold at implantation should not be taken as the criterion for changing the pacing site immediately.

关 键 词：心脏起搏器 螺旋电极 起搏阈值 

分 类 号：R541.7[医药卫生—心血管疾病]