心电图判断起搏器主动固定电极的可靠性

Role of the 12-lead ECG machine on active fixed lead implanted pacemaker reliability

目的探讨永久性起搏器植入术中，体表12导联心电图判断主动固定电极固定的可靠性的意义。方法选择2011年1月至2012年8月我院心内科住院的56例患者，男37例，女19例，年龄55．73岁，平均65±9岁，符合永久性起搏器植入适应证。右室电极采用流出道间隔部主动固定电极，12导联心电图，连接好肢体导联，而V，导联连接起搏电极远端，记录心内膜损伤电流，同时与美敦力公司2290型起搏器分析仪直接测量的损伤电流进行对比。结果V，导联测定的损伤电流sT段弓背上抬振幅至少≥5mV1且高于R波振幅，持续至少5rain时，与美敦力公司2290型起搏器分析仪直接测量的损伤电流的可靠指标相一致。螺旋电极旋出15min后，最后测定起搏参数，均符合起搏阈值≤1．0V、阻抗300～1000Ω、R波振幅≥5．OmV156例患者中，除3例右室流出道植入失败，被迫改为心尖部起搏外，另53例临床3个月随访发现，无一例电极脱位。结论12导联心电图机V1导联测定的损伤电流，可以作为起搏器主动固定电极植入可靠性的一项指标。

Objective To investigate the reliability of 12-Lead ECG on implanting active-fixation lead of permanent pacemaker. Methods From Jan. 2011 to Aug. 2012,56 patients（male 37 and female 19） according with the research standard were choosen into the study, All of the patients were according to the indications of permanent pacemaker implantation. During the process of implantions, the right ventricular adopt active fixation leads with right ventricular septum pacing. Besides conventionally judging pacing parameter with pacing maker analyzer, we used 12-lead ECG in connection with limb lead, and lead of V connected the distant side of pacemaker lead,recording endocardial injured current, contrast with the current which were measured by pacing maker analyzer, Medtronic Model 2290. Results We found that the current of injury recorded by lead of VI was consistent with the current measured by Pacing maker analyzer, Medtronic Model 2290. Measured pacing parameter when active-fixation leads spun out 15minutes ago,according to the standard of pacing thresholds ≤ 1.0V,impedance 3001000Ωand R wave ≥ 5.0mV.In this study,3 patients were forced apex pacing because of the failure of ventricular outflow pacing, and there were no dislocation happened in another 53 pitients during 3 months follow-up. Conclusions The injured current measured by V of 12-lead ECG was treated as a reliable index in active-fixation lead of permanent pacemaker implanted.