无导线起搏器在起搏装置感染移除术后患者中的初步临床应用  

Preliminary clinical application of leadless pacemaker in patients after removal of infected pacemaker system

作　　者：白剑[1] 蓝荣芳[1] 徐伟[2] 吉文庆[1] 张新林[1] 韩钟霖 吴翔 马冬辉[1] Bai Jian;Lan Rongfang;Xu Wei;Ji Wenqing;Zhang Xinlin;Han Zhonglin;Wu Xiang;Ma Donghui(Department of Cardiology,Nanjing Drum Tower Hospital,The Affiliated Hospital of Nanjing University Medical School,Nanjing 210008,China)

机构地区：[1]南京大学医学院附属鼓楼医院心内科,210008 [2]南京大学医学院附属鼓楼医院房颤中心,210008

出　　处：《中华心律失常学杂志》2021年第1期56-60,共5页Chinese Journal of Cardiac Arrhythmias

基　　金：国家自然科学基金(81870291)。

摘　　要：目的探讨在起搏装置感染移除术后患者中植入无导线起搏器的可行性和安全性。方法连续纳入2019年12月至2020年11月在南京大学医学院附属鼓楼医院移除感染起搏装置后植入无导线起搏器患者,回顾性分析手术相关参数(手术时间、X线曝光时间、X线曝光量)、起搏电学参数(阈值、R波振幅、阻抗)及手术相关并发症。结果共入选10例患者,男7例,女3例,年龄(76.2±6.0)岁,其中9例患者为囊袋感染,1例为感染性心内膜炎。所有患者均完整移除感染起搏装置并成功植入无导线起搏器(Micra,美国美敦力公司),植入部位均为右心室中位间隔部。平均手术时间(65.0±24.8)min,平均X线曝光时间(9.6±2.3)min,平均X线曝光量(212.6±96.4)mGy。植入时起搏电学参数:阈值(0.5±0.2)V/0.24 ms、R波振幅(9.0±2.2)mV、阻抗(687.0±120.9)Ω。围术期未出现心脏穿孔、心脏压塞、血管并发症、深静脉血栓、器械移位、装置感染、胸痛、血胸等不良事件。结论在起搏装置感染移除术后患者中植入无导线起搏器是安全、可行的,无导线起搏器将为此类患者提供新的治疗选择。Objective To investigate the feasibility and safety of implanting a leadless pacemaker in patients after removal of infected pacemaker system.Methods In this study,patients with leadless pacemaker implanted after removal of infected pacemaker system in Nanjing Drum Tower Hospital from December 2019 to November 2020 were consecutively enrolled.The procedure-related parameters(procedure time,X-ray exposure time,X-ray exposure dose),pacing electrical parameters(pacing threshold,R wave amplitude,impedance),and complications were analyzed.Results A total of 10 patients were enrolled,including 7 in male and 3 in female,with an average age of(76.2±6.0)years.Among them,9 patients had pocket infection and 1 patient had infective endocarditis.All patients had completely removed the infected pacemaker system and successfully implanted a Micra leadless pacemaker.All Micra leadless pacemakers were implanted in the medium septum of right ventricule.The average procedure time was(65.0±24.8)min,the average X-ray exposure time was(9.6±2.3)min,and the average X-ray exposure dose was(212.6±96.4)mGy.The pacing electrical parameters at implantation:pacing threshold(0.5±0.2)V/0.24 ms,R wave amplitude(9.0±2.2)mV,impedance(687.0±120.9)Ω.No adverse events such as cardiac perforation,cardiac tamponade,vascular complications,deep vein thrombosis,device displacement,device infection,chest pain,hemothorax were observed during the perioperative period.Conclusion It is safe and feasible to implant leadless pacemaker in patients after removal of infected pacemaker system,and leadless pacemaker will provide new treatment options for such patients.

关 键 词：心脏起搏器 人工 无导线起搏器 起搏装置感染 导线拔除 

分 类 号：R541.7[医药卫生—心血管疾病]