心脏起搏器电极脱位原因的初步探讨

Discuss the cause and of pacemaker lead dislocation

目的随访起搏器置入术后患者,观察起搏电极导线脱位的情况,分析和探讨电极导线脱位的原因。方法总结1065例置入起搏器患者的临床资料,24例起搏器电极导线脱位,7例为VVI/VVIR起搏器,其余15例为DDD/DDDR起搏器。结果共24根电极导线脱位,其中15例电极导线明显移位,9例电极导线微脱位,11根为心室电极导线,13根为心房电极导线。脱位电极导线中23根为双极电极导线,1根为单极电极导线。脱位后3例发生晕厥,3例有黑矇症状。结论心房电极导线脱位率高于心室电极导线,大多数电极导线脱位发生于术后1周内。双极电极导线在临床应用增多后引起的起搏电极脱位率高于单极电极导线,老年人合并基础心脏疾病者电极导线脱位的危险性增高。此外,电极导线脱位与术者置入经验可能有关。

Objective To follow up the patients with pacemaker, observe the condition of pacemaker lead dislocation, to explore the cause of lead dislocation. Results Summarizing the clinical data of 1065 patients with pacemakers, 7 patients with VVI/VVIR pacemakers and 15 patients with DDD/DDDR pacemakers. Methods We report 24 pacemaker leads dislocation, 15 leads were visible dislocated, 9 leads were mildly dislocated , including 11 ventricular leads, 13 atria leads. During the dislocation leads,23 were bipolar leads ,and one was unipolar lead .After the dislocation,3 patients had syncope ,3 patients had the pre-syncope. Conclusions The ratio of dislocation of atria leads was higher than ventricular leads , most of the dislocation happened during one week after implanting. The ratio of dislocation has been increased following the wide use of bipolar leads in clinical practice, compared with the unipolar leads. The elderly patients with heart disease had high risk of lead dislocation. In addition,the occurrence of lead dislocation is associated with the experience of operator.