无导线起搏器术中发生心内膜夹层的危险因素分析  

Analysis of risk factors for endocardial dissection during leadless pacemaker implantation

作　　者：尚帅 张疆华[1] 吕华胜 魏猛 梁小燕 杨徐 郭衍楷 贾索尔·肖克热提 祖克拉·吐尔洪 李耀东[1] 邢强[1] 周贤惠[1] 芦颜美[1] 汤宝鹏[1] Shang Shuai;Zhang Jianghua;Lyu Huasheng;Wei Meng;Liang Xiaoyan;Yang Xu;Guo Yankai;Jiasuoer·Xiaokereti;Zu Kela·TuErhong;Li Yaodong;Xing Qiang;Zhou Xianhui;Lu Yanmei;Tang Baopeng(Department of Pacing and Electrophysiology,Xinjiang Key Laboratory of Cardiac Electrophysiology and Cardiac Remodelling,The First Affiliated Hospital of Xinjiang Medical University,Urumqi 830054,China)

机构地区：[1]新疆医科大学第一附属医院心脏起搏电生理科、新疆心电生理与心脏重塑重点实验室,乌鲁木齐830054

出　　处：《中华心律失常学杂志》2024年第5期386-392,共7页Chinese Journal of Cardiac Arrhythmias

基　　金：新疆维吾尔自治区重点研发计划(2022B03023-1)。

摘　　要：目的探讨无导线起搏器植入术中发生心内膜夹层的危险因素。方法本研究为前瞻性观察性研究,连续纳入2019年12月至2024年5月于新疆医科大学第一附属医院接受无导线起搏器植入术的患者。收集患者的一般临床资料,如年龄、体重指数、既往基础病史,左心室射血分数(LVEF)、左心房内径等超声心动图指标,手术分组(根据术者手术熟练程度,按患者手术时间进行分组),术中释放无导线起搏器的右心室间隔部位等。观察术中是否发生心内膜夹层,通过单因素及多因素Logistic回归分析与术中发生心内膜夹层的关联,进一步绘制受试者工作特征(ROC)曲线观察单独指标与联合指标的预测性能。结果共纳入573例成功植入无导线起搏器患者,年龄75(65,82)岁,其中男338例(58.99%,338/573),左心房内径为38(35,40)mm,LVEF为61.90(58.96,63.69)%,既往冠心病史129例(22.51%,129/573),糖尿病史116例(20.24%,116/573),高血压史299例(52.18%,299/573)。术中发生心内膜夹层13例(13/573,2.3%),多因素Logistic回归结果显示,年龄(OR=1.09)和高位室间隔(OR=8.06)是术中发生心内膜夹层的独立危险因素,术者熟练程度(OR=0.42)、左心房内径(OR=0.87)、LVEF升高(OR=0.89)是独立保护因素。年龄的ROC曲线下面积(AUC)为0.701(95%CI 0.569~0.834),LVEF的AUC为0.672(95%CI 0.546~0.798),左心房内径的AUC为0.699(95%CI 0.525~0.874),手术分组AUC为0.785(95%CI 0.696~0.874),间隔部位AUC为0.605(95%CI 0.484~0.725),上述指标联合AUC为0.908(95%CI 0.856~0.960)。结论年龄升高、LVEF下降、左心房内径偏小、高位室间隔和术者不熟练是无导线起搏器植入术中发生心内膜夹层的独立危险因素,以上联合预测效能较高。Objective To investigate the risk factors for endocardial dissection during leadless pacemaker implantation.Methods This was a prospective observational study that consecutively included patients who underwent leadless pacemaker(Micra)implantation at the First Affiliated Hospital of Xinjiang Medical University from December 2019 to May 2024.General clinical data were collected from the patients,including age,body mass index,underlying medical history,and echocardiographic indices such as left ventricular ejection fraction(LVEF)and left atrial diameter(LAD).Additionally,surgical grouping was determined based on the operator’s proficiency and the time of the surgery.The site of the right ventricular septum where the leadless pacemaker was implanted intraoperatively was also recorded.We observed whether endocardial dissection occurred intraoperatively,analysed the association with the occurrence of intraoperative endocardial dissection by univariate and multivariate logistic regression,and plotted receiver operating characteristic(ROC)curves to observe the predictive performance of individual and combined indicators.Results A total of 573 patients who successfully underwent implantation of leadless pacemakers were included,with an age of 75(65,82)years.Among them,338 were male(58.99%,338/573),the LAD was 38(35,40)mm,and the LVEF was 61.90(58.96,63.69)%.There were 129 cases(22.51%,129/573)of coronary heart disease,116 cases(20.24%,116/573)of diabetes mellitus,and 299 cases(52.18%,299/573)of hypertension.During the procedure,endocardial dissection occurred in 13 cases(13/573,2.3%).The results of multifactorial Logistic regression showed that age(OR=1.09)and elevated interventricular septum(OR=8.06)were independent risk factors for intraoperative endocardial dissection and that operator experience(OR=0.42),LAD(OR=0.87)and increased LVEF(OR=0.89)were independent protective factors.The area under the ROC curve(AUC)for age was 0.701(95%CI 0.569-0.834),AUC for LVEF was 0.672(95%CI 0.546-0.798),AUC for left atrial diamete

关 键 词：心脏起搏器 人工 无导线起搏器 心内膜夹层 并发症 危险因素 室间隔 

分 类 号：R542.4[医药卫生—心血管疾病]