右室中位间隔起搏的可行性与安全性

Safety and feasibility of right ventricular mid-septal pacing in patients with implantation of cardiac pacemaker

目的评价中位右室间隔起搏(RVSP)方法的可行性和安全性。方法选择101例行RVSP,右室心尖部起搏(RVAP)126例作对照。在X线指导下将室间隔分四区,分别为His束区、右室流出道间隔区、低位前间隔区和右室流入道间隔区,精确定位RVSP的主动导线在中位间隔位置。记录术中曝光时间、电极导线植入参数、心电图和术后第3,6,12个月随访资料。结果两组手术曝光时间无差异。RVSP组起搏前后的QRS波形态有稳定的特征性变化,可结合X线用于指导导线定位。RVSP组起搏后的QRS波时限明显小于RVAP组(98.19±22.30 msvs 120.80±24.14 ms,P<0.01),术中两组的心室导线的起搏阈值、电流、阻抗均存在明显差异(0.76±0.30 V vs0.39±0.10 V,0.98±0.52 mA vs 0.36±0.19 mA,690.67±141.64Ωvs 867.16±201.23Ω,P<0.01)。在随访中两组心室起搏阈值和阻抗较稳定。结论在X线指导下将室间隔分区,主动导线能精确、快捷地固定于右室中位间隔部。该部位是较理想的起搏部位,安全可行。

Objective To investigate the feasibility and safety in patients with right ventricular mid-sepal pacing （RVSP） with active fixation lead. Methods All patients who underwent successful implantation of permanent pacemak- ers, included 101 cases with RVSP and 126 cases with standard right ventricular apical pacing （ RVAP）, were enrolled. Guided by X ray in RAO 30~ view, the right ventricular septum was divided into four zones, namely His bundle zone, out- flow tract zone, low anteroseptum zone and inflow tract zone , respectively . X-ray exposure time, parameters of leads im- plantation, ECG were recorded during operation. The follow-up data of 3, 6 and 12 months post implantation were recorded too. Results X-ray exposure time was similar between two groups. Pacing QRS wave configuration in RVSP group was specific and stable, which was useful to guide the leads location. Pacing QRS duration in RVSP group was shorter than that in RVAP group significantly （98.19 ±22.30 ms vs 120.80 ±24.14 ms, P 〈0.01 ）. Stimulation threshold, electric current and impedance had significant difference between two groups during leads implantation（0.76 ± 0.30 V vs 0.39 ± 0.10 V, 0.98 ±0.52 mA vs 0. 36 ±0.19 mA, 690.67 ± 141.64 Ω vs 867.16 ±201.23 Ω, respectively, P 〈0.01 ）. However, ventricular lead parameters were acceptable with stable long-term stimulation thresholds and impedance in period of follow- up. Conclusion By the guidance of ventricular septum subarea under X ray, active leads can be fixed in mid-septum accurately and rapidly. The RVSP is feasible and safe.