3830导线在选择性心室起搏的应用及近期安全性观察

Application and safety of 3830 lead for selective ventricular pacing

目的探讨使用Select Secure系统的3830导线及配套的C304或C315的递送装置完成选择性心室起搏的有效性和近期安全性。方法对122例符合起搏器植入指征的患者都使用了Select Secure系统包括3830导线和配套的递送装置行选择性心室起搏,首选希氏束部位起搏(HBP),如HBP失败改为间隔部或右室心尖部起搏(RVAP),术中观察指标包括:操作时间、记录心房及心室电极的起搏参数(即刻R波高度、阻抗、阈值)、术中脱位率等相关并发症。术后随访内容:术后第1个月进行随访并记录心房及心室起搏参数、H-V传导性、导管脱位、心包积液等并发症。结果成功HBP 98例,右室间隔起搏20例,RVAP4例。HBP术后随访无一例电极因参数变化导致失用,1例于术后第8天导线脱位;1例出现心包积液;至今无一例死亡。术后1个月随访阈值和感知与术中无差异(P>0.05),阻抗降低(P<0.001)。24例右室间隔部和RVAP无并发症。结论 3830导线和配套的专用输送鞘在选择性心室起搏,特别用于HIS束起搏是目前操作较为简便且容易定位并固定安全、有效的器材。

Objective To investigated the effectiveness as well as the safety of selective ventricular pacing using 3830 lead from the Select Secure system and its accessory C304/C315 delivery catheter. Methods One hundred and twenty- two patients with a pacemaker implantation were enrolled in this study. All patients chose to use the Select Secure system which includes 3830 lead and its specific delivery catheter. His-branch pacing（HBP） was preferred in our study. However, in those cases while HBP failed, right ventricular septum or right ventricular apex pacing was done. Operation time, pacing parameters of atrial and ventricular electrode （including immediate R wave amplitude, impedance and threshold） , dislocation rate and other complications were observed. Follow-up was done one month after operation, pacing parameters of atrial and ventricular lead, H-V conductivity, dislocation of lead, hydropericardium and other complications were recorded. Results Among all 122 patients involved in this study, 3830 leads were successfully implanted into His Bundle in 98 patients. For the remaining patients whose operation was failed, 3830 leads were changed to implant into right ventricular septum in 20 patients and right ventricular apex in the other 4 patients. No lead was found to be non-functional because of variation of parameters after operation among patients with HBP. Dislocation of lead was found in one patient 8 days after the operation; One patient was diagnosed with hydropericardium; No patients died until now. 1-month follow-up study showed that the parameters （pacing threshold and R wave amplitude） were consistent with the preceding intraoperative process （ P〉0.05 ）, while impedance was significantly decreased （ P〈 0.01 ）. No complication was found in those 24 patients with right ventricular septum or right ventricular apex pacing. Conclusion 3830 lead as well as its specific delivery catheter are simple to operate, easy to locate and fix, safe and effective equipments applying to selective ventricular pacing especially to HBP.