心室主动固定电极导线固定时损伤电流特征分析

Characteristics of current of injury at the time of fixation of active fixation pacing leads

目的探讨主动固定电极导线植入心肌后急性损伤电流(COI)的特征及持续时间,指导COI在临床上使用。方法对59例首次植入起搏器患者植入心室主动固定电极导线时,用Medtronic 2290起搏器分析仪测定旋前;旋后1,5,10 min的COI,打印出来并记录。结果一共尝试66次,59次固定稳定及阈值良好,7次旋后出现高阈值或急性脱位。心室主动固定电极导线固定稳定且阈值良好时,55例(93.2%)在旋后1 min有COI,54例(91.5%)在旋后5 min有COI,50例(84.7%)旋后10 min仍有COI。而旋后1 min出现高阈值或急性脱位时,旋后1min均无COI(P<0.001),ST80均≤0 mV(P<0.001)。结论主动固定电极导线螺旋旋出后固定稳定及阈值良好时,旋后1 min可见到明显COI,并可持续10 min以上,而电极导线急性脱位或阈值较高时,旋后1 min无COI或ST80≤0 mV。

Objective To discuss the characteristics and length of time of current of injury（ COI） after adequate placement of active-fixation pacing leads（ AFPL） for better clinical use. Methods Fifty-nine patients undergoing active-fixation lead implantation were enrolled. R wave amplitude,COI（ maximum and at 80 ms） measured by a Medtronic pacing system analyzer（ model 2290） from baseline to 10 min after AFPL implantation were recorded. Results Right ventricular lead positioning was attempted 66 times; 59 positions demonstrated good fixation and adequate threshold compared to 7 positions demonstrated high threshold or acute lead dislodgement. 55 sites of good fixation（ 93. 2%） showed adequate COI at 1 minute after fixation of AFPL and lasted for 5 minutes in 54 sites（ 91. 5%） and for 10 minutes in 50 sites（ 84. 7%）. while site of high threshold showed no COI and ST 80（ the amplitude 80 ms after onset of the R wave deflection） ≤0 mV at 1 minute after fixation of AFPL（ P 0. 001）. Conclusion The development of adequate COI within 1 minute after fixation of AFPL can last 10 minutes when the AFPL demonstrated good fixation and had satisfactory threshold. Conversely,no COI or ST 80 ≤0 mV appeared 1 minute after fixation of AFPL as the AFPL showed high threshold or acute lead dislodgement.