心房螺旋电极导线临床应用的可行性和安全性  

The clinical feasibility and safety of active fixation atrial leads

作　　者：高洁[1] 王晓群[1] 李畅[1] 王义龙[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脏科,200025

出　　处：《国际心血管病杂志》2017年第6期360-364,共5页International Journal of Cardiovascular Disease

摘　　要：目的:探讨心房起搏使用螺旋电极导线(主动固定电极导线)的可行性和安全性。方法:入选2015年11月至2016年6月在瑞金医院心脏科置入埋藏式人工心脏双腔起搏器的患者,共109例。根据心房电极导线的类型分为螺旋电极组(n=68)和被动固定电极组(n=41),观察两组在置入术中即刻和术后1、3个月的起搏参数变化及并发症等情况。结果:螺旋电极组术中即刻起搏阈值明显高于被动固定电极组[(1.12±0.40)V对(0.67±0.28)V,P<0.01],术后1、3个月[(0.49±0.12)V及(0.42±0.13)V]较术中即刻明显降低(P均<0.01),但与被动固定电极组[(0.45±0.16)V及(0.41±0.15)V]相比差异无统计学意义;螺旋电极组术后3个月的起搏阈值明显低于其术后1个月的起搏阈值(P<0.01)。螺旋电极组术中即刻[(454.56±82.51)Ω对(526.51±93.06)Ω]、术后1个月[(370.53±87.86)Ω对(533.63±89.64)Ω]、术后3个月[(371.07±86.14)Ω对(535.17±90.64)Ω]的阻抗均明显低于被动固定电极组(P均<0.01);螺旋电极组术后1、3个月的阻抗均明显低于其术中即刻阻抗(P均<0.01),术后1、3个月之间的阻抗无统计学差异。螺旋电极组术中即刻[(2.84±1.17)mV对(3.20±1.34)mV]、术后1个月[(2.75±1.36)mV对(3.15±1.42)mV]、术后3个月[(2.61±1.27)mV对(3.03±1.31)mV]的感知与被动固定电极组相比均无统计学差异;螺旋电极组各时间点之间的感知也均无统计学差异。两组患者均未发生心包炎、心包填塞、心脏穿孔等并发症。结论:应用心房螺旋电极导线行心脏起搏治疗安全可行。Objective： To explore the feasibility and safety of active fixation atrial leads for atrial pacing. Methods：From November 2015 to June 2016, a total of 109 consecutive patients undergoing implantation of dual chamber pacemaker in Ruijin hospital were retrospectively analyzed for implantation with active fixation atrial lead model （AF group, n = 68） versus passive fixation model （PF group, n = 41）. The pacing parameters and complications were recorded immediately, 1 and 3 months after operation. Results：Pacing thresholds at implantation in AF group were significantly higher than those in PF group [（1.12 ± 0. 40） V vs. （0. 67 ± 0. 28） V, P〈0. 01], which decreased dramatically 1 and 3 months after operation [（0. 49 ± 0. 12） V and （0. 42 ± 0. 13） V vs. （1.12 ± 0. 40） V, both P〈0. 011, but had no statistically significant difference when compared with PF group [（0.45 ± 0. 16） V and （0. 41 ± 0. 15） V]. Pacing thresholds of AF group at 3 months after operation were significantly lower than those at 1 month after operation （P（0. 01）. The impedances in AF group were significantly lower than those in PF group at implantation [（454. 56 ± 82. 51）Ω vs. （526. 51 ± 93.06）Ω], 1 months after operation [（370. 53 ± 87. 86）Ω vs. （533. 63 ± 89. 64） Ω] and 3 months after operation [（371.07 ±86. 14）Ω vs. （535.17 ± 90. 64）Ω] （all P〈0. 01）. The impedances of AF group at 1 and 3 months after operation were significantly lower than those at operation （both P（ 0. 01 ）, while the impedance differences between 1 and 3 months after operation had no statistical significance. The sense between AF and PF group had no statistical difference at implantation [（2. 84 ± 1.17） mV vs. （3.20 ± 1.34） mV], 1 months after operation [（2. 75 ± 1.36） mV vs. （3. 15 ± l. 42） mV], and 3 months after operation [（2. 61 ± 1.27） mV vs. （3. 03 ± 1.31） mV]. Meanwhile, the sense of AF group among different time points all had no statis

关 键 词：心脏起搏器 心房螺旋电极 被动固定电极 起搏参数 

分 类 号：R541.7[医药卫生—心血管疾病]