携带心脏植入式电子设备患者对医源性干扰的预防处理和临床结局  

Management of Interference Due to Medical Procedures in Patients With Cardiac Implantable Electronic Devices and the Association With Outcomes

作　　者：王玉玲[1] 夏驭龙[1] 金汉 陈尔冬[1] 贺鹏康[1] 蒋捷[1] 盛琴慧[1] 褚松筠[1] 周菁[1] WANG Yuling;XIA Yulong;JIN Han;CHEN Erdong;HE Pengkang;JIANG Jie;SHENG Qinhui;CHU Songyun;ZHOU Jing(Department of Cardiology,Peking University First Hospital,Beijing 100034,China)

机构地区：[1]北京大学第一医院心内科,北京100034

出　　处：《中国循环杂志》2023年第9期951-956,共6页Chinese Circulation Journal

基　　金：国家重点研发项目重大专项(2017YFC1307704);北京大学第一医院临床研究基金(2017CR20)。

摘　　要：目的:探讨携带心脏植入式电子设备(CIED)患者对医源性干扰的预防处理和临床结局。方法:回顾性连续纳入2018年3月至2022年12月期间在北京大学第一医院心内科接受MRI、外科手术以及放射治疗的CIED患者219例。调查具有潜在干扰的医疗操作前后的处置与最近欧洲心律学会发表的关于预防和管理CIED患者医疗程序引起干扰的共识建议的依从度,并分析与CIED相关终点事件和主要心血管终点事件的相关性。CIED相关主要终点事件定义为导线功能异常需更换,起搏失夺获或误治疗;次要终点事件包括阈值、感知和电极阻抗改变达到预设值;主要心血管终点事件包括院内心肌梗死、心力衰竭、心律失常及死亡。结果:共纳入219例患者,平均年龄(74.4±11.2)岁,男性137例(62.6%)。医疗操作类型包括MRI检查84例(38.4%)、外科手术127例(58.0%)、放射治疗8例(3.6%)。总体操作前CIED评估、准备和操作后管理与最新国际共识规范处理的依从度分别为44.7%、95.9%和95.9%。CIED相关主要终点事件发生率为0.9%,CIED相关次要终点事件发生率达17.8%,主要心血管终点事件发生率为15.5%。多因素Logistic回归分析显示,心力衰竭史(OR=6.4,95%CI:2.0~20.2,P=0.002)、进行外科手术(OR=84.5,95%CI:5.2~1367.1,P=0.002)以及发生CIED相关终点事件(OR=19.1,95%CI:1.7~215.7,P=0.020)均是主要心血管终点事件的独立危险因素。规范的医疗操作前评估和准备是心血管终点事件的保护因素(OR=0.1,95%CI:0.1~0.4,P<0.001)。结论:医源性干扰影响CIED功能,本研究医疗操作前后的处理较最新国际共识规范处理存在差距。规范的操作前评估和准备有助于确保CIED安全有效运作,改善患者心血管结局。Objectives:To explore the possible association between the management of interference due to medical procedures and their in-hospital outcomes in patients with cardiac implantable electronic devices(CIED).Methods:The peri-procedure management of the retrospective CIED cohorts admitted to Peking University First Hospital from Mach 2018 to December 2022 undergoing MRI,surgery,and radiotherapy(RT)were evaluated according to current EHRA consensus on prevention and management of interference due to medical procedures.The association between the degree of standardization of the care and in-hospital outcomes was analyzed.The primary CIED-associated endpoints were defined as lead dysfunction requiring replacement,loss of capture,or inappropriate implantable cardioverter defibrillator(ICD)therapy.The secondary CIED-associated endpoints included the altered pre-specified value of the pacing threshold,sensitivity,and impedance of the leads.The primary cardiac endpoints were defined as in-hospital myocardial infarction,heart failure,arrhythmia,or death.Results:A total of 219 patients(average age:[74.4±11.2]years,137 males[62.6%])were included.The involved medical procedures included 84(38.4%)MRI,127(58.0%)surgery,and 8(3.6%)RT.Adherence to the recommendation for pre-procedure evaluation,preparation,and follow-up in the consensus was as follows:44.7%,95.9%,and 95.9%.The primary and the secondary CIED-associated endpoints were noted in 0.9%and 17.8%of the cases,respectively.The primary cardiac endpoints occurred in 15.5%of the patients.Multivariate Logistic regression analysis showed that history of heart failure,undergoing surgery,and occurrence of CIED-associated endpoints were the independent risk factors of the primary in-hospital cardiac adverse events(OR=6.4,95%CI:2.0-20.2,P=0.002;OR=84.5,95%CI:5.2-1367.1,P=0.002;OR=19.1,95%CI:1.7-215.7,P=0.020,respectively),while standardized peri-procedure management was associated with lower cardiac events(OR=0.1,95%CI:0.1-0.4,P<0.001).Conclusions:CIED dysfunction might be induced b

关 键 词：心脏植入式电子设备 医源性干扰 医疗操作 心血管终点事件 

分 类 号：R54[医药卫生—心血管疾病]