具有心房感知的右心室除颤电极导线临床应用体会

Clinical application of right ventricular defibrillator leads with floating atrial sensing bipolar electrodes

目的探讨存在右心房漂浮感知双极线圈的右心室除颤电极导线(A+ICD电极)在单腔埋藏式心律转复除颤器(ICD)患者临床应用中的疗效及安全性。方法回顾性分析沈阳军区总医院心内科28例植入配备A+ICD电极(Linox Smart SDX65)的A+ICD心律转复除颤器(Lumax 540 VR-T DX)患者的临床资料,通过家庭监护(HM)长期观察右心房感知、右心室导线阈值、阻抗及感知参数;术后3个月诊室随访,观察卧位、坐位、立位时心房感知的变化,以及心房腔内图在单腔心律转复除颤器中的作用。结果本组28例患者手术均成功,平均随访(704.57±308.73)d。出院前及术后1、3、6、12个月的右心房感知振幅、右心室导线感知、阈值、阻抗间比较,差异均无统计学意义(P>0.05)。所有患者术后3个月卧位、坐位及立位的右心房感知振幅比较,差异均无统计学意义(P>0.05)。右心房腔内心电图早期发现房性心律失常并跟踪房性心律失常的管理,协助室性心动过速与室上性心动过速的鉴别诊断,优化房室顺序起搏。结论 A+ICD电极导线长期心房及心室参数稳定,通过A+ICD电极导线可获取稳定的心房感知、参与房室顺序起搏及房性心律失常的早期识别和管理。

Objective The study was performed to evaluate the clinical effect and safety of ventricular defibrillator lead（A ＋ ICD lead） with floating atrial sensing bipolar electrodes in patients with implantable cardioverter defibrillator（ICD）. Methods Totally 28 patients were implanted ICD（ Biotronik Germany Lumax 540 VR-T DX） with A ＋ ICD lead（ Linox Smart SDX65）. Long-term right atrial sensing,right ventricular threshold,lead impedance,sensing parameters were collected by home monitoring（ HM） system and analyzed. Clinical follow-up was performed at 3 months after intervention,atrial sensing changes were observed in supine,sitting and standing position; and how atrial intracardiac electrocardiogram works in a single chamber implantable cardioverter defibrillator was observed. Results All 28 patients were implanted successfully,and the mean follow-up periods were（ 704. 57 ± 308. 73） days. No significant changes were found in atrial sensing,ventricular sensing,threshold,as well as impedance before discharge,one month,three months,six months,and 12 months after intervention. Three months after 28 patients＇ intervention,no significant changes in atrial sensing were found while patients were in supine or sitting or standing position. Atrial sensing helped early identify and manage atrial arrhythmias,facilitate differential diagnosis of superventricular tachycardia and ventricular tachycardia,and optimize atrioventricular sequential pacing. Conclusion A ＋ ICD lead could provide stable long-term atrial and ventricular lead parameters. A ＋ ICD lead could help acquire stable atrial sensing,which leads to atrioventricular sequential pacing,and early identification and management of atrial arrhythmias.