心房螺旋电极导线与翼状电极导线起搏阈值随访分析

Comparison of long-term follow-up results between active fixation lead and passive fixation in right atrial

目的对比安置双腔起搏器患者植入右心房螺旋电极与翼状电极导线的起搏阈值。方法 60例安置永久性人工心脏起搏器的患者,其中右心房植入Medtronic 5076-52螺旋电极导线30例(螺旋电极组),同期植入Medtronic IMK 49JB-53心房翼状电极导线30例(翼状电极组),分别于植入时采用Medtronic5318测试仪测试心房导线起搏阈值,电流,阻抗,P波振幅及植入后1周、1个月、3个月、6个月、12个月测试心房导线起搏阈值。结果术后1周两组阈值均较植入时明显升高(P<0.05),翼状电极导线组升高更明显(P<0.01),但两组间阈值差异无统计学意义(P>0.05)。术后1个月阈值最高,3个月后逐渐下降稳定,两组阈值在随访期内差异均无统计学意义(P>0.05)。随访期内两组均无电极导线断裂、脱位、心包填塞、心肌穿孔、胸痛等并发症发生。结论应用螺旋电极固定于右心房行永久起搏安全可行。

Objective The aim of this study was to compare the long term pacing threshold between active fixation lead and passive fixation in right atrial. Methods Sixty patients received dual-chamber pacemaker. The patients were subdivided into two group according to the type of atrial lead ： group 1 （ 30 patients, MedtronicS076-52 atrial active fixation lead ） and group 2 （ 30 patients, Medtronie IMK49JB-53 atrial passive fixation lead）. Stimulation thresholds, current, impedance and p wave amplitude were assessed during implantation. Atrial pacing thresholds in 1 week, 1 month,3 months ,6 months and 12 months after implantation were examined. Results After 1 week of the implantation, the thresholds were significantly increased in the two groups （ P 〈 0. 05 ） with more obvi- ousness in the passive fixation lead group （ P 〈 0. 01 ） although there was no significant difference between the two groups. After 1 month of the implantation, thresholds in the two groups were the highest. After 3 months of the implantation, thresholds were gradually decreased and finally stabilized. The pacing thresholds between the two groups were not statistically significant differences during the follow-up periods. No complications such as fracture, dislocation, pericardial tamponade, cardiac perforation or chest pain was observed in the two groups during the whole follow-up period. Conclusions The results suggest that active fixation lead in right atrial may be feasible.