摘要
目的探索伴有右心耳切除术的患者起搏器植入术中使用心房主动固定电极导线的长期适应性和稳定性。方法入选85例病窦综合征或Ⅱ度或高度房室传导阻滞的患者并且分为,切除组(n=22)行右心耳切除术且植入双腔起搏器,保留组(n=63)未行心外科手术即右心耳保留患者行双腔起搏器。分别于植入时(0天)、1天;3、6、12、24和36个月进行起搏参数测定(起搏阈值、P/R振幅和阻抗)、植入时以及每年一次X线摄片、心脏超声检查以及电极导线植入术中和术后起搏器相关并发症的随访。结果所有电极导线植入位置均保持稳定。两组患者心房、心室电极导线的初始感知灵敏度相当(P>0.05)且长期保持稳定。从植入术时至1个月,电极导线阻抗轻微下降(前后比较,P>0.05),且随后保持稳定。心房电极导线的起搏阈值从植入时至术后3个月随访时有降低趋势(P>0.05),在随后的随访中保持稳定,心室起搏电极导线的起搏阈值在随访全程中保持稳定,且两组间不存在显著性差异(P>0.05)。但两组术前术后自身比较可见左、右心房直径、左室舒张/收缩末内径有缩小,射血分数值有一定降低,但均无显著性差异(P>0.05)。随访全程两组患者未发现电极导线穿孔、移位等起搏器相关并发症发生。结论心房主动固定电极导线可成功地植入到行右心耳切除术后患者的心耳基底部,在长期随访中起搏器电极导线参数满意且保持稳定。
Objective To investigate the long-term feasibility and stability of active-fixation pacing leads following amputation of right atrial appendage. Methods Active-fixation leads were used in 85 consecutive sick sinus syn- drome or high atrioventricular block patients with （Group 1, n=22） or without （Group 2, n= 63） amputation of right atrial appendage （RAA） underwent implantation of dual-chamber pacemakers. X-ray, echocardiography, threshold, sensing, impedance and lead-related complications were evaluated at implantation （0 day）, and at 1, 3, 6, 12, 24, and 36 months. Results All leads were successfully implanted. Over long-term follow-up, all leads remained stable as evidenced by X-ray. Initial sensing of both groups were equal and stable in both groups. Impedance declined slightly from 0 day to 1 month and remained stable thereafter. Threshold of atrial pacing lead decreased significantly during the first 3 months and remained stable thereafter while the threshold of ventricular pacing lead remained stable throughout the whole study, with neither of them showing significant difference between groups. No lead-related complications were found. Conclusions Active-fixation atrial pacing leads can be successfully fixed to the bottom of the residual appendage in patient undergone amputation of right atrial appendage with overall good and stable long-term parameters. [Chinese Journal of Cardiac Pacing and Electrophysiology ,2016,30（3） ：216-219]
出处
《中国心脏起搏与心电生理杂志》
2016年第3期216-219,共4页
Chinese Journal of Cardiac Pacing and Electrophysiology
