磁共振兼容心脏植入型电子器械临床应用分析

Analysis of clinical application of magnetic compatible cardiac implantable electronic device in a Chinese population

目的 分析单中心磁共振兼容心血管植入型电子器械（CIED）的临床应用情况和磁共振检查的安全性.方法 回顾性收集了2011年8月至2016年12月在浙江大学医学院附属第二医院心内科植入磁共振兼容CIED的545例患者,分析其临床基本特征和磁共振检查的需求,观察磁共振检查对磁共振兼容CIED参数的影响.结果 545例患者中,男307例,平均年龄（69.2±13.0）岁.合并高血压324例（59.4%）、冠心病138例（25.3%）、糖尿病90例（16.5%）、脑卒中史72例（13.2%）、骨关节病史30例（5.5%）、肿瘤病史52例（9.5%）.植入单腔起搏器37例、双腔起搏器486例、植入型心律转复除颤器（ICD）17例、心脏再同步治疗起搏器（CRT-P）2例、心脏再同步治疗除颤器（CRT-D）3例.术前131例（24.0%）进行磁共振检查共145例次,检查部位：头颅106例次、四肢4例次、脊椎20例次、肝胆胰7例次、心脏4例次、其他4例次.术后21例患者进行磁共振检查共24例次,其中头颅13例次、四肢3例次、脊椎3例次、肝胆胰3例次、其他部位2例次.磁共振检查后起搏参数无显著改变.结论 磁共振兼容CIED临床应用呈显著上升趋势,植入磁共振兼容CIED后磁共振检查安全有效.

Objective The study was aimed to analyze the clinical application of magnetic compatible cardiac implantable electronic device （CIED） and influence of magnetic resonance investigation （MRI） on the parameters of CIED from our center.MethodsAll of the 545 patients implanted magnetic compatible CIED from August 2011 to December 2016 in the Second Affiliated Hospital,Zhejiang University School of Medicine were enrolled retrospectively.The baseline characteristics and the necessity of MRI were analyzed.We observed the changes of the parameters of CIED after MRI.ResultsAmong 545 patients,307 were male,and 238 were female,with an average age of （69.2±13.0） years old.Hypertension was found in 324（59.4%） patients,diabetes in 90（16.5%） patients,stroke in 72（13.2%） patients,coronary heart disease in 138（25.3%） patients,osteoarthropathy in 30（5.5%） patients,cancer in 52（9.5%） patients.Thirty-seven patients had single-chamber pacemaker,486 patients had dual-chamber pacemaker,17 patients had implantable cardiac defibrillator （ICD）,2 patients had cardiac resynchronization therapy pacemaker（CRT-P）and 3 patients had cardiac resynchronization therapy defi brillator（CRT-D）.Before the implantation,131 patients underwent 145 times of MR scan.In which 106 times for head,4 times for extremities,20 times for spine,7 times for hepatobiliary and pancreatic diseases,4 times for the heart and 4 times for other parts of the body.Post-procedural MR scan were carried out in 21 patients for 24 times.Among them,13 times were for the head,3 times for extremites,3 times for spine,3 times for hepatobiliary and pancreatic diseases,and 2 times for other parts of the body.The observation showed there was no significant change of parameters of CIED after MRI scanning.ConclusionThere is a growing trend for applying magnetic compatible CIED,and the request for MR scan in Chinese population might differ from those of foreign countries.MR scan is safe and effective for the patients with magnetic compatible CIED according to our center＇s experience.