心脏植入式电子装置电极导线与三尖瓣反流的相关性研究  

Study on the correlation between cardiac implantable electronic device electrode leads and tricuspid regurgitation

作　　者：晋宇阳 王建华 徐健[1] 李述峰[1] 曹威[1] JIN Yu-yang;WANG Jian-hua;XU Jian;LI Shu-feng;CAO Wei(Department of Cardiology,Second Affiliated Hospital of Harbin Medical University,Harbin 150000,China)

机构地区：[1]哈尔滨医科大学附属第二医院心内科,黑龙江哈尔滨150000

出　　处：《中国介入心脏病学杂志》2025年第3期141-149,共9页Chinese Journal of Interventional Cardiology

摘　　要：目的 探讨现阶段心脏植入式电子装置电极导线的操作方式、电极导线的粗细及数目对三尖瓣反流的影响。方法 本研究为单中心、回顾性研究,连续入选2019年1月至2024年1月于哈尔滨医科大学附属第二医院首次植入心脏植入式电子装置并在(10±4)个月内门诊随访的患者。收集患者一般临床资料、术前和门诊随访超声心动图等各项指标。根据操作方式的不同分为递送鞘组、支撑钢丝组及递送鞘联合支撑钢丝组。在仅1根电极导线跨三尖瓣的前提下,依据电极导线粗细不同分为3830 69电极组(4.1 F)、5076 58/Solia S60电极组(7 F)及6935M-65cm除颤电极组(9 F)。在均衡操作方式及电极材质的前提下,电极导线数目对比分为3830 69电极亚组及6935M-65cm除颤电极亚组进行探讨。比较各组术后三尖瓣反流的变化。结果 共入选219例患者,年龄(65.92±12.04)岁。不同植入方式、不同导线粗细及不同导线数目中6935M-65cm除颤电极亚组植入前各组三尖瓣反流情况差异均无统计学意义(均P>0.05),3830 69电极亚组中2根电极组植入前重度反流者占比较高(P=0.013),但随访时发生三尖瓣反流加重的情况与1根电极组差异无统计学意义。在电极导线植入前与随访时三尖瓣反流变化情况的对比中,6935M-65cm除颤电极亚组中≥2根电极组三尖瓣反流情况较1根电极组意外改善,1根电极组随访时瓣膜反流加重高于植入≥2根电极组(P=0.019)。结论 植入电极导线的操作方式、电极导线粗细均未导致三尖瓣反流变化情况产生明显差异;单纯植入1根6935M-65cm除颤电极会导致三尖瓣反流加重,而与生理性起搏结合带来的获益会抵消电极导线对瓣膜的不良影响,为今后植入策略的选择提供了指向性证据。Objective To investigate the effect of operation mode,thickness,and number of implanted electrode leads on tricuspid regurgitation.Methods This was a singlecenter retrospective study.Patients who received their first cardiac implantable electronic device at the Second Affiliated Hospital of Harbin Medical University from January 2019 to January 2024 and were followed up within(10±4) months were continuously enrolled.General clinical data,preoperative and outpatient follow-up echocardiography,and other indicators were collected.According to the different operation modes,patients were divided into delivery sheath group,support wire group,and delivery sheath combined support wire group.Under the premise of only one electrode wire crossing the tricuspid valve,according to the different thicknesses of the electrode wire,they were divided into 3830 69 group(4.1 F),5076 58/Solia S60 group(7 F),and 6935M-65cm defibrillator group(9 F).The number of electrode wires was divided into 3830 69 subgroup and 6935M-65cm defibrillator subgroup under the premise of balanced operation mode and electrode material.The changes in tricuspid valve regurgitation were compared in each group.Results A total of 219 patients,aged(65.92±12.04) years,were enrolled.There was no difference in tricuspid valve regurgitation in the 6935M-65cm defibrillator subgroup before implantation(all P>0.05).In the 3830 69 subgroup,there was a higher proportion of severe regurgitation in the two-electrode group before implantation(P=0.013).In comparison with the change in tricuspid valve regurgitation before electrode wire implantation and during follow-up,the regurgitation of the tricuspid valve in the 6935M-65cm defibrillator subgroup with≥2 electrodes was unexpectedly improved compared to that in the group with one electrode,and the regurgitation of the valve in the group with one electrode was more severe than that in the group with≥2 electrodes implantation(P=0.019).Conclusions The operation mode and thickness of the implanted electrode lead did not

关 键 词：心脏植入式电子装置 电极导线 三尖瓣反流 心律失常 

分 类 号：R54[医药卫生—心血管疾病]