主动固定电极在右心室起搏中的临床应用价值

Application of Active Fixation Lead in Right Ventricular Pacing

目的探讨主动固定电极在右心室起搏中的应用。方法对68例患者行右心室主动固定电极起搏器植入治疗,测量螺旋电极固定后即刻和15min后ST段抬高程度和起搏参数。比较不同部位起搏心电图QRS时间,随访6个月。结果53例螺旋电极固定后15min损伤电流及起搏阈值较即刻低(7.07±0.1 1mV vs 1.50±0.23mV;1.19±0.40V vs 0.69±0.12 V,均P<0.01)。15例无损伤电流的患者中,6例发生脱位,9例因阈值偏高而重新定位。起搏心电图QRS时间右心室流出道间隔部和右心室中部间隔较右心室心尖部及流出道游离壁短(P<0.01)。出院后1、3、6个月随访无导线脱位。起搏参数与植入时比较无明显差异(P>0.05)。结论主动固定导线心脏起搏安全可行,右心室流出道间隔或右心室中部间隔是合适的起搏部位。

Objective To explore application of active fixed lead in right ventricular pacing. Methods 68 patients underwent implantation of right ventricular pacer using active fixed leads.The magnitude of ST-segment elevation（STSE） and pacing parameters were measured immediately and 15 min later after lead fixation. Pacing QRS duration was mea-sured and compared among different pacing sites. Al patients were fol owed up for 6 months. Results The magnitude of STSE decreased from 7.07± 0.11 mV to1.50±0.23mV （P〈0.01）, pacing threshold from 1.19± 0.40 V to 0.69±0.12 V （P〈0.01）, at 15 min after lead fixation in 53 cases. Of 15 cases without STSE, 6 had lead dislocation during operation and 9 had higher pacing thresholds. Pacing site was readjusted in these cases. There was no lead dislocation and no signifi-cant change of pacing parameters during 6 months＇ fol ow-up （P〉0.05）. The QRS duration during pacing at the septum of right ventricular outflow tract and middle septum was shorter than that at right ventricular apical and RVOT free wal （P〈0.01）. Conclusion The active fixation lead pacing is feasible and safe.The septum of right ventricular outflow tract and right ventricular middle septum are suitable pacing sites.