主动固定电极右室不同部位起搏的研究

Active fixation electrodes in different parts of the right ventricular pacing

目的探讨主动固定电极导线行右心室不同部位起搏的可行性和安全性。方法对68例需要安置心脏起搏器患者放置主动固定电极导线,描记起搏心电图测定QRS时间、有关参数,并随访观察。结果手术顺利完成,未出现严重并发症。共使用主动电极导线68根。出院后1、3、6个月随访无电极导线脱位,起搏参数与置入时差异无统计学意义。右室流出道间隔部和右心室中部间隔起搏心电图QRS时间较短,但两者间差异无统计学意义,两者与右心室心尖部及流出道游离壁起搏QRS时间差异有统计学意义。结论使用主动固定电极进行心脏特殊部位起搏是可行和安全的。为获得较窄的QRS波形,建议将电极固定在右心室流出道的高位间隔面或者右室中部间隔。

Objective To explore the feasibility and safety of right ventricular pacing with active fixed leads,and to in-vestigate the physiological pacing site by observing body-surface electrocardiogram QRS duration during different pacing site.Methods Sixty-eight patients were implanted active fixed leads for permanent pacemaking.QRS time was measured by recording pacing electrocardiogram（ECG）.Some parameters were measured and observed during the follow-up time.Results All the cases came through the operation successfully with no serious complications.Sixty-eight active fixed leads were used.The patients were followed up in one,three and six months after being discharged.No case of wire dislo-cation happened and the parameters showed no significantdifference in the follow up period.The QRS duration during pac-ing in the RVOT ventricular septum and right ventricular middle septum was shorter than that in the right ventricular apical and in the RVOT ventricular free wall（ P〈0.01）,but there was no difference in RVOT ventricular septum and right ven-tricular middle septum（P〉0.05）.Conclusions The special cardiac site pacing by the active fixation lead is feasible and safe.The pacing site of RVOT ventricular septum or right ventricular middle septum should be suggested to gain narrower QRS duration.