心律植入装置感染拔除后行无导线起搏

Clinical efficacy of leadless pacing implantation after cardiovascular implantable electronic devices infection extraction

目的观察心律植入装置感染拔除后植入无导线起搏器的临床疗效及安全性。方法回顾性观察2020年11月至2022年5月,在中国科学技术大学附属第一医院(安徽省立医院)因心律植入装置感染拔除后植入无导线起搏器的患者,分析术中起搏器阈值、感知、阻抗,手术时间、X线曝光时间、曝光量,并发症情况以及随访过程中的临床疗效。结果共计6例患者,其中男性4例,女性2例,平均年龄71.8岁,其中起搏器囊袋感染5例,感染性心内膜炎1例。其中双腔起搏器5例,单腔起搏器1例,植入起搏器导线4个月到13年不等,共拔除11根电极导线。所有患者均顺利拔除起搏器装置并成功植入无导线起搏器,均植入右室间隔部。术中起搏器参数为:阈值(0.46±0.12)V/0.24ms,感知(8.48±2.46)mV,阻抗(753.3±131.4)Ω,随访3个月起搏器各项参数稳定。拔除及重新植入围手术期及3个月随访过程中,未出现心脏穿孔、静脉血栓、血管损伤、装置功能不良等并发症。结论心律植入装置感染后拔除再植入无导线起搏器,临床疗效确切,安全性高。

Objective To observe the clinical efficacy and safety of leadless pacing implantation after cardiovascular implantable electronic devices infection extraction.Methods Retrospective observation from November 2020 to May 2022,patients with leadless pacing implantation after cardiovascular implantable electronic devices infection extraction at the first affiliated hospital of university of science and Technology of China(Anhui provincial hospital),to analyze intraoperative pacemaker threshold,sensing,impedance,operation time,X-ray exposure time,exposure,complications and clinical efficacy during follow-up.Results A total of 6 patients,including 4 males and 2 females,with a mean age of 71.8 years,including 5 pacemaker pocket infections and 1 infective endocarditis.There were 5 cases of dual-chamber pacemaker and 1 case of single-chamber pacemaker.The implantation of pacemaker leads ranged from 4 months to 13 years,a total of 11 leads were extracted.Pacemaker devices were successfully extracted and leadless pacing(Micra,Medtronic USA)were successfully implanted in all patients.All the devices were implanted in right ventricular septum.Intraoperative pacemaker parameters were as follows.The threshold was(0.46±0.12)V/0.24ms,the sensing amplitude was(8.48±2.46)mV,and the impedance was(753.3±131.4)Ω.These parameters of pacemaker were stable during the 3-month follow-up.No adverse complications,such as,cardiac perforation,venous thrombosis,vascular injury,and device dysfunction occurred during the perioperative period of extraction and re-implantation and the 3-month follow-up.Conclusions Leadless pacing implantation after cardiovascular implantable electronic devices infection extraction,clinical efficacy is exact,high safety.