右室流出道室间隔主动电极和右室心尖部被动电极的对照研究

A comparative study between right ventricular outflow tract ventricular septal pacing and right ventricular apical pacing

目的探讨采用主动电极行右室流出道(RVOT)室间隔起搏的可行性和安全性。方法需要安置体内埋藏式心脏起搏器的100例患者,随机分为二组,50例用主动固定电极行RVOT室间隔起搏术(主动电极组),50例用被动固定电极行右室心尖部起搏术(被动电极组),记录两组在术中及术后的各项参数并进行比较。结果两组均顺利完成手术,未出现严重并发症。两组固定次数、曝光时间无差异(1.7±1.3次vs1.3±0.5次,7.9±5.2minvs5.4±4.4min,P均>0.05)。主动电极置入后即刻可达到理想阈值,比被动电极高(0.6±0.27Vvs0.5±0.25V,P<0.05),被动电极阻抗比主动电极高(911±225.31Ωvs668±168.03Ω,P<0.05),两组的感知阈值无差异。术后随访1个月时,两组的起搏阈值无差异。主动电极组2例,被动电极组1例出现导线脱位。结论使用主动电极行RVOT室间隔起搏是安全可行的。

Objective To explore the feasibility and safe of right ventricular outflow tract （RVOT） ventricular septal pacing. Method One hundred patients implanted with pacemaker, were randomly separated into two groups. One group underwent the RVOT ventricular septal pacing with the active fixation electrodes （ Active electrode group, n = 50）, the other underwent the right ventricular apical pacing with the passive fixation electrodes （ Passive electrode group, n = 50）. Recorded the parameter of two groups in and after operation and compared accordingly. Result Operations in two groups came off smoothly and there were no complications . There was no difference between the active and passive electrode in terms of times of fixation and exposure time. After implantation of active electrode , it soon reached satisfying pacing thresholds, higher than passive electrode. But the passive electrode pacing impedance was higher than active one. There was no difference in R-wave sensing between two groups. There was no difference between the two groups in pacing thresholds after one month of operation. The active electrode group had 2 cases of wire dislocation, while the passive group had one. Conclusion It is feasible and secure to pace from RVOT septum with active electrode. [ Chinese Journal of Cardiac Pacing and Electrophysiology, 2007,21 （ 3 ） ： 203 - 205 ]