损伤电流在主动电极导线植入术中的临床价值和应用  

The value of current of injury for implantation of active lead in permanent pacemaker

作　　者：盛琴慧[1] 褚松筠[1] 王玉玲[1] 蒋捷[1] 李康[1] 陈尔冬[1] 金汉 周菁[1] SHENG Qin-hui;CHU Songyun;WANG Yu-ling;JIANG Jie;LI Kang;CHEN Er-dong;JIN Han;ZHOU Jing(Department of Cardiology,First Hospital of Peking University,Beijing 100034,China)

机构地区：[1]北京大学第一医院心内科,北京100034

出　　处：《中国心脏起搏与心电生理杂志》2021年第2期158-162,共5页Chinese Journal of Cardiac Pacing and Electrophysiology

摘　　要：目的探讨损伤电流(COI)对主动电极导线植入的指导作用和意义。方法选取心房、心室均为主动电极导线新植入的双腔起搏器患者,记录电极旋入心肌即刻、旋入后5 min的COI,同时测试该时间点的起搏参数(COI组);选取相同条件同期植入但术中未记录COI、只测试起搏参数的患者作为常规对照(常规组)。分析COI不同时间点的变化规律及心房、心室COI的特点,比较两组参数及长期随访的结果。结果共纳入85例患者,COI组40例,常规组45例。COI组中,主动电极导线旋入后即刻,COI即达到最高峰,图形特点明显,表现为最大幅度的PR段或ST段抬高[心房(2.81±0.57)mV,心室(10.12±2.38)mV]和最长的腔内心电图时限[心房(252±29)ms,心室(322±38)ms]并持续5 min以上;心房、心室旋入后即刻阈值显著高于旋入后5min心房(1.83±0.89)V vs(1.10±0.61)V,心室(0.91±0.37)V vs(0.59±0.23)V,P均≤0.001,COI明显但阈值高的患者延长等待时间可获得明显下降的阈值,避免反复更换电极位置。两组的近期和远期随访参数均维持在正常范围,与常规组相比,COI组长期起搏参数更趋稳定。结论主动电极导线的起搏阈值通常数分钟内稳定下降,常规起搏参数可满足多数患者术中测试的需要;显著的COI,常预示阈值会有明显的下降,在心房电极导线表现更为明显,术中选择性使用,对即刻短暂的高阈值有较好的判别和指导作用。Objective To assess the value and usefulness of current of injury(COI)during the active lead implantation.Methods Forty patients implanted the permanent pacemaker with active atrial and ventricular leads were enrolled as group COI,in which both COI and general pacing parameters(pacing threshold,impedance,and sense)were recorded at 0 min and 5 min after lead fixation.Another 45 patients only tested by general pacing parameters were enrolled as General group.The difference of COI and pacing threshold between each time,distinguished features of atrial and ventricular leads,and the follow up results in both groups were analyzed and compared.Results In Group COI,the most obvious COIs were recorded immediately after fixation,with prominent elevated PR or ST segment[in atrium(2.81±0.57)mV,in ventricle(10.12±2.38)mV],and the longest intracardiac EGM duration[in atrium(252±29)ms,in ventricle(322±38)ms],all maintained more than 5 min.Pacing thresholds improved significantly in ventricular and atrial leads after 5 min,P≤0.001.The follow up of both groups were good while group COI showed more stable pacing parameters.Conclusions An obvious COI indicates a subsequent improvement in pacing threshold,especially for the atrial active lead,is helpful to determine if the leads need to be replaced during the implantation.[Chinese Journal of Cardiac Pacing and Electrophysiology,2021,35(2):158-162]

关 键 词：心血管病学 损伤电流 主动电极 起搏器植入 

分 类 号：R318.11[医药卫生—生物医学工程]