经静脉电极导线拔除后无导线起搏器植入单中心经验  

Single Center Experience of Leadless Pacemaker Implantation After Lead Extraction

作　　者：昃峰[1] 李鼎[1] 周旭 王龙[1] 段江波[1] 吴寸草[1] 苑翠珍[1] 何金山[1] 杨丹 李学斌[1] ZE Feng;LI Ding;ZHOU Xu;WANG Long;DUAN Jiangbo;WU CuncaoY;UAN Cuizhen;HE Jinshan;YANG Dan;LI Xuebin(Department of Cardiology,Peking University People's Hospital,Beijing(100044),China)

机构地区：[1]北京大学人民医院心内科,北京市100044

出　　处：《中国循环杂志》2022年第12期1238-1244,共7页Chinese Circulation Journal

基　　金：北京大学人民医院研究与发展基金(RDL2022-19)。

摘　　要：目的:探讨经静脉电极导线拔除后再植入无导线起搏器的安全性及有效性。方法:连续纳入2020年1月至2022年4月在北京大学人民医院行无导线起搏器(LP)植入的患者,分为电极导线拔除后再植入LP组(再植入LP组)和首次植入LP组,对比分析两组的手术时间、植入部位、释放次数、术后QRS时限。随访两组植入1周、1个月、3个月、1年时起搏参数情况。结果:共入选51例LP植入患者,其中男性30例(58.8%),平均年龄(73.2±13.6)岁。再植入LP组33例(64.7%),其中男性18例(54.5%),平均年龄(69.9±12.2)岁。首次植入LP组18例(35.3%),其中男性12例(66.7%),平均年龄(79.2±14.2)岁。再植入LP组31例(93.9%)患者因囊袋感染行电极导线拔除手术。所有患者LP均植入成功,1例(2.0%)术中发生心包积液,穿刺引流后好转。48例(94.1%)患者植入间隔部位。与首次植入LP组相比,再植入LP组释放≤2次比例、起搏阈值、感知、阻抗、手术时间、起搏QRS波群时限差异均无统计学意义(P均>0.05)。中位随访时间为20.1(11.3,31.3)个月,无起搏相关的并发症。1年随访时,与首次植入LP组相比,再植入LP组起搏阈值、感知、阻抗差异均无统计学意义(P均>0.05)。结论:经静脉电极导线拔除后植入LP安全有效。Objectives:To explore the feasibility,safety and efficacy of the implantation of leadless pacemaker(LP)in patients who have previously undergone transvenous lead extraction(TLE).Methods:Clinical data of patients admitted to People's Hospital of Peking University from January 2020 to April 2022,who received leadless pacemaker implantation,were retrospectively analyzed.Results:A total of 51 patients(30 males[58.8%],aged[73.2±13.6]years old)were included in this study.In 33 out of 51 patients(18 males[54.5%],aged[69.9±12.2]years old),leadless pacemakers were reimplanted after TLE(LP re-implantation group).Indication to TLE was infection in 31 patients(93.9%),bacteremia in one patient(3.0%),superior vena cava syndrome in one patient(3.0%).In 18 out of 51 patients(12 males[66.7%],aged[79.2±14.2]years old),leadless pacemaker were implanted for the first time(naïve group).The implantation procedure was successful in all patients.Pericardial effusion occurred in one patient during the procedure,and the patient recovered after pericardial punction and drainage.No devicerelated events occurred during follow-up(20.1[11.3,31.3]months).The implant site was the septum in 48 patients(94.1%).No differences were observed between the LP re-implantation group and the naïve group in the rate of≤two times of device delivery,procedure time,QRS duration,electrical performance at implant.No differences were observed between the naïve group and the LP re-implantation group at 12-month follow-up in pacing threshold,impedance,R wave amplitude(all P>0.05).Conclusions:Leadless pacemaker implantation is an effective and safe procedure in patients after TLE,associated with similar electrical performance and outcome compared with patients who had no history of leads extraction at long-term follow-up.

关 键 词：经静脉电极导线拔除 起搏器再植入 无导线起搏器 心脏植入电子装置感染 

分 类 号：R541.4[医药卫生—心血管疾病]