右心室流出道间隔部主动电极和右室心尖部被动电极起搏的长期疗效及安全性研究

Comparative study between right ventricular outflow tract pacing and right ventricular apical pacing

目的探讨右心室流出道间隔部(RVOTS)的主动电极和右心室心尖部(RVA)的被动电极起搏的长期临床疗效及安全性。方法选择2007年2月—2013年12月在新疆医科大学第一附属医院确诊的严重缓慢型心律失常患者1 001例。根据心室电极导线的类型分为RVOTS组(521例)和RVA组(480例)。比较两组患者起搏器植入术后即刻、术后1w及术后1、6、12、18、24个月心室起搏电极相关的基本参数以及手术并发症。结果RVOTS组术后即刻起搏阈值[(0.77±0.28)V]比RVA组[(0.53±0.17)V]高,差异有统计学意义(P<0.05)。RVOTS组术中曝光时间[(18.76±8.43)min]比RVA组[(9.66±4.35)min]长,差异有统计学意义(P<0.05)。两组在术后1w及术后1、6、12、18、24个月起搏阈值差异无统计学意义,两组感知阈值及电极阻抗在不同时点的差异均无统计学意义(P>0.05)。两组起搏参数均在可接受范围内且长期保持稳定。RVOTS组心脏穿孔并发症发生率高于RVA组,差异具有统计学意义(P<0.05)。两组在随访期间心脏超声测量各参数及心功能指标均未见明显差异(P>0.05)。RVA组随访中房性心律失常事件的发作次数、持续时间较RVOTS组高(P<0.05)。结论主动螺旋电极在RVOTS起搏是可行的,长期随访起搏参数稳定。但是当主动螺旋电极固定于RVOTS并指向前壁或游离壁可能增加心脏穿孔风险。

Objective The aim of this study was to compare the pacing parameters of right ventricular out-flow tract septal （RVOTS）pacing with active-fixation leads and right ventricular apical （RVA）pacing with passive-fixation leads.To evaluate the long-term safety and reliability of RVOTS pacing.Methods 1001 patients were diagnosed bradyarryhthmia from February 2007 to December 2011.Group RVOTS （n =521）and Group RVA （n =480）were paced in RVOT with activefixation leads and right ventricular apex （RVA）with passivefixation leads respectively.This controlled clinical study compared the difference between pacing parameters and complication.These evaluations were performed 1 week and 1,6,12,18, 24 months after implantation.Results Pacing threshold during implantation in Group RVOTS [（0.77± 0.28）V]was significant higher than Group RVA [（0.53±0.17）V].The manipulation time and X-ray exposure time was significant longer than Group RVA （18.76±8.43 vs9.66±4.35）min （P 〈0.05）.But the pacing threshold had no significant difference between the two groups 1 week after implantation.There was no difference in longterm sensing or impedance.The pacing parameters maintained in the normal range for a long time.The rate of perforation was significant higher in Group RVOTS than Group RVA （P〈0.05）.Echocardiography value and cardiac function had no significant difference in both of the two groups （P 〈0.05）.The atrial arrhythmia in Group RVOTS was more frequent than Group RVA （P 〈0.05）.Conclusion Right ventricular outflow tract pacing site is safe.Pacing parameters are comparable with conventional RVA pacing in the long-term.Comprehending the anatomy of RVOT is important to real septal pacing.3D and two curve stylets may facilitate the active-fixation lead perpendicular to the septum of RVOT.Direct to the anterior or free wall increase the risk of perforation.By means of hemodynamic effects of RVOTS pacing decrease the incidence of atrial arrhythmia.