心外膜永久起搏的随访观察  

Follow up observation of permanent epicardial pacemarkers.

作　　者：李佳 韩宏伟[1] 李振[1] 鄢华[1] 蒋萍[1] 易宏伟 开文龙 苏晞[1] 陶凉[3] LI Jia;HAN Hong-wei;LI Zhen;YAN Hua;JIANG Ping;YI Hong-wei;KAI Wen-long;SU Xi;TAO Liang(Department of Cardiology,Wuhan 430022,Hubei,China;Medical Records Statistics Room,Wuhan 430022,Hubei,China;Cardiac Surgery,Wuhan Asia Heart Hospital,Wuhan 430022,Hubei,China)

机构地区：[1]武汉亚洲心脏病医院心内科,湖北武汉430022 [2]武汉亚洲心脏病医院病案统计科,湖北武汉430022 [3]武汉亚洲心脏病医院心脏外科,湖北武汉430022

出　　处：《中国心脏起搏与心电生理杂志》2021年第6期529-533,共5页Chinese Journal of Cardiac Pacing and Electrophysiology

摘　　要：目的总结心外膜永久起搏器植入术安全性及长期疗效。方法选取2009年12月至2019年11月在武汉亚洲心脏病医院行心外膜永久起搏器植入术,且出院后至少进行1次程控随访的患者69例。儿童23例,均经右室心外膜植入单腔起搏器;成人46例,其中19例经左室心外膜放置起搏电极,27例经右室心外膜放置起搏电极。随访术后1周内、1~3个月、1~3年及5年以上的电极参数变化及不良事件。结果右室电极50例,其中37例固定于右室膈面,13例固定于右室流出道;左室电极19例,其中15例固定于左室侧壁,2例固定于左室后壁,2例固定于左室膈面。中位随访48.6个月。69例患者均顺利出院,无手术相关并发症。2例巨大左室心肌病心脏再同步化治疗(CRT)患者因心力衰竭死亡,1例CRT植入患者因疗效不佳于术后12个月行心脏移植。12例因起搏器电池耗竭更换脉冲发生器。4例电极断裂,1例囊袋感染。心外膜电极植入术后1周内、1~3个月、1~3年及5年以上心室阈值(中位数)分别为1.0 V/0.4 ms、0.75 V/0.4 ms、0.8 V/0.4 ms、1.0 V/0.4 ms。左室心外膜电极阈值各时间段与右室一致,儿童与成人一致。结论心外膜电极参数长期稳定,但安全性欠佳。Objective To summarize the long-term efficacy and safety of implanting permanent epicardial pacemakers.Methods A total of 69 patients implanted permanent epicardial pacemakers between December 2009 and November 2019 in Wuhan Asia Heart Hospital were included in this study.All the 69 patients were followed up for 1 or more times after discharge.Among them,23 were children,pacing single-chamber pacemakers,and electrodes were placed through the epicardium of the right ventricle.There were 46 adults,of which 19 had lead electrodes placed through the left ventricular epicardium,and 27 had pacing electrodes placed through the right ventricular epicardium.The electrode parameters and adverse events were obtained and analyzed retrospectively within 1 week,1 months,1-3 years and more than 5 years.Results Among 50 cases of right ventricular electrodes,37 cases were fixed to the right ventricular diaphragm surface,13 cases were fixed to the right ventricular outflow tract.Among 19 cases of left ventricular electrodes,15 cases were fixed to the left ventricular side wall,2 cases were fixed on the posterior wall of the left ventricle,and 2 cases were fixed to the left ventricular diaphragm surface.The patients were follow-up for 48.6 months.All the 69 patients were discharged from hospital without any complications related to surgery.Two patients with huge left ventricular cardiomyopathy with CRT implantation died of heart failure,and one patient with CRT implantation received a heart transplantation 12 months after the operation due to poor efficacy.The generators were replaced in 12 cases due to the exhaustion of the pacemaker battery.There were 4 cases of lead fracture and 1 case of lead infection.The median ventricular thresholds were 1.0 V/0.4 ms,0.75 V/0.4 ms,0.8 V/0.4 ms,1.0 V/0.4 ms at less than 1 week,1-3 months,1-3 years and over 5 years,respectively.The change trends of the epicardial ventricular capture threshold in left and right were consistent,the same as children and adults.Conclusion The parameters of epicard

关 键 词：心血管病学 心外膜起搏 电极断裂 心脏起搏器 心脏再同步化治疗 

分 类 号：R318.11[医药卫生—生物医学工程]