改良双弯曲指引导丝塑型法在右室流出道间隔部起搏电极定位中的应用

Application of modified dual-curved guidewire to position the pacing electrode in the right ventricular outflow tract septum

目的探讨改良双弯曲指引导丝塑型法在右室流出道间隔部起搏电极定位中的应用价值。方法选取72例行起搏器植入术患者,心室电极均定位于右室流出道间隔部,按电极指引导丝塑型法不同分为单弯曲指引导丝塑型法组(A组)、双弯曲指引导丝塑型法组(B组)、改良双弯曲塑型法组(C组);三组采用相同右室流出道主动固定起搏电极植入方法,对比三组电极起搏参数、起搏电极固定操作参数、定位成功率、手术并发症以及术后3个月随访情况。结果三组起搏阈值、电极阻抗和R波振幅无明显差异(P>0.05),术后起搏时QRS波时限C组较B组短(P<0.01);C组较A、B两组X线曝光时间短、电极固定次数少(P<0.05),与A组比较,C组电极固定成功率高(P<0.01);术后随访3个月,C组无明显并发症发生。结论采用改良双弯曲指引导丝塑型法在右室流出道间隔部起搏电极定位中操作更简易,手术定位成功率高。

Objective To investigate the application value of modified dual-curved guidewire to position the electrode in the right ventricular outflow tract septum. Method Seventy-two patients using ventricular electrodes positioned in the right ventricular outflow tract septum in the process of pacemaker implantation were recruited and divided into three groups according to the guide-wire shaping/modeling method as follows, a single curved wire group （group A）, dual-curved wire group（ group B） ,and ventricular outflow tract using the same method in the three groups. The electrodes pacing parame- ters, the fixed operating parameters of the pacing electrodes, the success rate of positioning, surgical complications were ob- served and the effect in the postoperative 3 month follow-up was investigated. Results It was no significant difference in pacing thresholds, electrode impedances and the amplitudes of R wave among the three groups, respectively （P〉 0.05 ）. However,compared with group B, the paced QRS duration after surgery was remarkable shorter than group C （ P〈0.01 ）. Among the three groups, the X-ray exposure time in group C was the shortest, while the electrode fixed times in group C was the fewest （P〈0.05） ,and the success rate of fixing electrode in group C was higher than in group A （P〈0.01）. No significant clinical complications were found among the three groups in the 3 month follow-up after surgery. Conclusion The intervention of the modified dural-curved guidewire in the pacing electrode positioning of the right ventricular outflow tract septum is much easier and effective with higher success rate.