起搏系统移除后植入无导线起搏器急性期有效性及安全性研究  

Acute-phase safety and efficacy of re-implanting leadless pacemakers in patients after lead extraction

作　　者：王吉芳 王静洁 吴翔 王天琦 韩钟霖 俞鸿飞 白剑[1] 蓝荣芳[1] 徐伟[1] Wang Jifang;Wang Jingjie;Wu Xiang;Wang Tianqi;Han Zhonglin;Yu Hongfei;Bai Jian;Lan Rongfang;Xu Wei(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,南京210008

出　　处：《中华心律失常学杂志》2024年第5期380-385,共6页Chinese Journal of Cardiac Arrhythmias

基　　金：南京市医学重点科技研发项目(ZKX22011)。

摘　　要：目的观察起搏系统移除术后再植入无导线起搏器(LP)急性期的安全性及有效性。方法本文为单中心回顾性研究。选取2019年1月至2023年12月在南京大学医学院附属鼓楼医院接受起搏系统移除治疗后再植入LP(Micra)为LP组和经静脉植入单腔起搏器(TVP)的患者为TVP组,比较两组患者基线资料,围手术期及术后30 d起搏阈值、阻抗等起搏器参数、并发症情况。结果共纳入102例患者,其中男74例,年龄(72.15±12.19)岁。LP组70例,TVP组32例,LP组抗生素使用时间、起搏器植入时间、术后住院天数、总住院天数更短[10.00(6.50,14.00)d对13.00(10.00,16.70)d,P=0.036;35.00(27.00,50.00)min对51.50(40.00,58.50)min,P=0.001;4.00(3.00,6.00)d对7.50(4.00,10.0)d,P<0.0001;13.00(10.00,19.00)d对15.00(11.75,26.50)d,P=0.027],起搏阈值更低[0.50(0.38,0.52)V对0.60(0.50,0.80)V,P=0.001],阻抗更高[(821.79±205.18)Ω对(678.56±143.69)Ω,P<0.001]。围手术期患者均有并发症发生,发生率差异无统计学意义[4.28%(3/70)对6.25%(2/32),P=1.000],术后30 d两组均无并发症发生。结论对于接受起搏系统移除治疗的患者,术后植入无导线起搏器同样是一种安全、有效的治疗手段。Objectives To compare the characteristics and acute-phase complications of patients implanted with leadless pacemakers or transvenous single-chamber pacemakers after lead extraction.Methods This was a retrospective single-center study.Patients who implanted with leadless pacemakers(Micra TPS,LP group)or transvenous single-chamber pacemakers(TVP group)after lead extraction at Nanjing Drum Tower Hospital from January 2019 to December 2023 were selected,and their characteristics,perioperative and 30 days postoperative parameters associated pacemaker(capture threshold,electrode impedance etc.)and the complications of two groups were compared.Results A total of 102 patients,74 males and 28 females,aged(72.15±12.19)years were included,70 patients in the LP group and 32 patients in the TVP group.Compared with the TVP group,the LP group had shorter duration of antibiotic use[10.00(6.50,14.00)d vs 13.00(10.00,16.70)d,P=0.036],time to device implantation[35.00(27.00,50.00)min vs 51.50(40.00,58.50)min,P=0.001],postoperative hospitalization[4.00(3.00,6.00)d vs 7.50(4.00,10.0)d,P<0.001],total hospitalization days[13.00(10.00,19.00)d vs 15.00(11.75,26.50)d,P=0.027],lower capture threshold[0.50(0.38,0.52)V vs 0.60(0.50,0.80)V,P=0.001],and higher electrode impedance[(821.79±205.18)Ωvs(678.56±143.69)Ω,P=0.000).During the perioperative period,there were complications in both groups,with no statistically difference in the rate of complications[4.3%(3/70)vs 6.3%(2/32),P=1.000].ConclusionsFor the patients after lead extraction,leadless pacemaker therapy is also a safe and effective treatment.

关 键 词：心脏起搏器 人工 无导线起搏器 单腔起搏器 急性期并发症 起搏系统移除术 

分 类 号：R541[医药卫生—心血管疾病]