电极导线在右室心尖部和右室流出道起搏的随访观察

Follow-up of right ventricular outflow tract and right ventricular apex pacing

目的评价螺旋电极导线行右室流出道(RVOT)间隔部起搏的可行性。方法连续入组195例具有植入起搏器适应证患者,术前随机分为螺旋主动固定电极导线的RVOT间隔起搏组(A组)和翼状被动固定电极导线的右室心尖部(RVA)起搏组(B组),两组中每例入选患者均分别行RVA和RVOT两个部位起搏测试,最后固定于相应的位置。比较两组术中手术时间、起搏参数、起搏QRS波宽度、手术成功率及起搏3个月、1年和2年后电极导线参数的变化。结果 A组99例,B组96例。两组起搏后QRS波宽度明显大于起搏前,B组起搏QRS波时限长于A组(176.46±24.54 ms vs 165.45±22.78 ms,P=0.001)。用于固定RVOT间隔部的曝光时间长于RVA。两组术中及术后并发症相似,R波振幅术后2年内及两组间无差别。术中A组起搏阈值高于B组(0.71±0.30 V vs0.56±0.19 V),术后2年内起搏阈值两组内及组间无差异。术后3个月时阻抗下降,A组的阻抗低于B组并持续整个随访期间。术后2年内超声心动图参数组内及组间无差别。结论采用螺旋主动固定电极导线进行RVOT起搏是安全可行的。

Objective To evaluate the feasibility of right ventricular outflow（RVOT） pacing with active fixation lead. Methods A total of 195 patients were enrolled sequentially who had indications for permanent pacemaker implantation and divided into two groups randomly. An active fixation lead was positioned in the septum of RVOT （group A） and a pas- sive lead was placed in right ventricular apex（RVA） （group B）. RVOT and RVA were placed pacing lead respectively for each patient and pacing parameters were recorded. The time of expose to X-ray, paced QRS duration, success of implantaion were studied and pacing parameters including pacing thresholds, impedances and amplitude of R-wave were compared at 3 month,1 year and 2 year after pacing. Results There were 99 patients in group A and 96 patients in group B. The paced QRS duration was longer in Group B than in Group A （176.46 ± 24.54 ms vs 165.45 ±22.78 ms, P = 0. 001 ）. Fixation for RVOT took more time of expose in X-ray than that for RVA. The complications and amplitude of R-wave during operation and follow-up were not different in two groups. The pacing thresholds of fixed screw leads were higher than wing ones during the operation（0.71 ±0.30 V vs 0.56±0.19 V）. However, there were no difference in the two year＇s follow up between group A and B. Three months later, the impedances of both groups were lower than that in the operation room, while the impedances of group A were lower than group B. Parameters of echocaridiogram showed no change during this pe- riod in the two groups. Conclusions The usage of active fixation lead for long-term pacing RVOT is feasible and safe.