主动固定电极在右室流出道间隔部起搏中的应用研究

The study on the application of active fixation leads in patients with right ventricular septum pacing

目的评价主动固定电极在右室流出道间隔部起搏应用中的可行性和稳定性。方法160例起搏适应证患者随机分为两组,每组80例,一组采用主动固定电极行右室流出道间隔部起搏(简称主动固定电极组),另一组应用被动固定电极行右室心尖起搏(简称被动固定电极组),观察电极置入时间和心电图QRS波宽度,电极置入后随访观察起搏阈值、感知、阻抗,电极脱位及相关并发症。结果主动固定电极组的置入时间和X线曝光时间均长于被动固定电极(26.34±6.54minvs20.86±4.32min,16.78±5.38minvs8.67±4.52min;P均<0.01)。主动固定电极组电极置入15min时较置入即刻的起搏阈值明显下降(0.76±0.21mVvs1.12±0.25mV,P<0.01)。主动固定电极组起搏的QRS波时限较被动固定电极组短(0.14±0.04msvs0.16±0.03ms,P<0.01)。术后随访1,3,6个月,两组的起搏阈值、感知、阻抗均无差异,未见电极脱位等并发症。结论主动固定电极在右室流出道间隔部起搏中的应用是可行和稳定的。

Objective To evaluate the feasibility and stability of the application of active fixation leads with right ventricular septum pacing. Methods One hundred and sixty patients were divided into two groups randomly, 80 patients each group. An active fixation lead was positioned in right ventricular septum（ for group Ⅰ ） and a passive lead was placed in right ventricular apex（ for group Ⅱ ）. Both the time for leads planting and the width of the QRS waves were recorded. Then pacing thresholds, sensation, impedances, lead dislocation and its complications were compared at 1,3, and 6 months after the operation. Results Group Ⅰ took more time to plant leads and expose in X-ray than group Ⅱ （26.34 ± 6.54 min vs 20.86 ± 4.32 min, 16.78 ± 5.38 min vs 8.67 ± 4.52 min ; all P 〈 0.01 ）. At 15 minutes after the active fixation lead was planted, the pacing threshold dropped dramatically compared with the one done immediately （0.76 ± 0.21 mV vs 1.12 ± 0.25 mV, P 〈 0.01 ）. The width of the QRS wave of group Ⅰ was narrower than that of group Ⅱ （0.14 ± 0.04 ms vs 0.16 ±0.03 ms, P 〈0. 01 ）. There was no significant difference in the pacing threshold between the two groups, and no patient was found whose lead was extracted. Conclusions The usage of active fixation lead in patients with ventricular septum pacing is feasible and steady. [ Chinese Journal of Cardiac Pacing and Electrophysiology,2007,21 （3） ：206 -208 ]