右室螺旋电极植入的参数变化

The changes of parameter after implanting the spiral electrode in right ventricle

目的观察右室螺旋电极旋出后即时、20 min及术后1个月随访的电极参数变化,探讨右室螺旋电极的参数变化规律。方法回顾分析植入右室螺旋电极患者依术中腔内心电图及参数测试调整电极固定部位,分别固定于右室流出道、间隔部及心尖部;观察术后并发症及右室螺旋电极旋出后即时、20 min及术后1个月随访的电极参数变化。结果 1共入选57例均植入手术成功,其中电极固定于右室流出道26例,间隔部25例,心尖部6例,电极旋出后即时、20 min心尖部较间隔部及流出道起搏阈值明显增高(P均<0.05);2电极旋出20 min后阈值下降30%左右;随后阈值又会缓慢渐渐升高,术后1个月接近于即时的阈值(P>0.05),阈值变化在达到安全起搏范围内存在"两峰一谷"的曲线;3螺旋电极旋出固定后1个月较20 min后的阈值变化幅度和变化比例大(P<0.05)。结论为保证术后长期的安全起搏,主动螺旋电极旋出前起搏参数满意而旋出后即时阈值增高时,也必须尽量追求电极旋出即时阈值达标。

Objective To observe the changes of parameter after turning out the spiral electrode immediately, 20 mi- nutes and a month after the surgery and discuss the change rules of electrode parameters to guide the implantation and pre- vent complications. Method Retrospective analysed the patients who were implanted the spiral electrode . In accord- ance with the intracardiac electrogram and parameter testing to adjust the position for fixing the electrode. They were fixed respectively in right ventricular outflow tract, interval and apex. To observe the postoperative complications and the parame- ter changes after turning out the spiral electrode immediately, 20 minutes and a month after the surgery. Results ①All Fifty-seven patients were implanted electrodes successfully. 26 electrodes were fixed in the right ventricular outflow tract, 25 electrodes were fixed in the interval, 6 electrodes were fixed in the apex. Comparing with the pacemaker thresholds in the interval, the pacemaker thresholds in the apex increased significantly after turning out the spiral electrode immediately and 20 minutes（P〈0.05 ）. ②the pacemaker threshold dropped about 30% after turning out the spiral electrode for 20 minutes. And then the pacemaker threshold rose gradually and slowly. A month after the surgery, the pacemaker thresholds were close to the pacemaker thresholds of turning out the spiral electrode immediately （ P〉0.05 ）. The threshold changes exist ＂ two peaks and a valley ＂ of the curve within the security paeemaking. ③The ranges of variation and the ratios of the thresh- olds after turning out the spiral electrode for a month were bigger than the thresholds after turning out the spiral electrode for 20 minutes. Conclusion To ensure the long-term pacemaker safety after the surgery, though the pacemaker parameters which before turning out the spiral electrode are normal, after turning out the spiral electrode are higher, we should also try to pursue a standard threshold after turning out the spiral electrode immediately.