感染电极拔除术后主动固定临时起搏与传统临时起搏的对比研究

Comparison of efficacy and safety of temporary pacing using active-fixation rersus traditional leads after extraction of infected leads

目的比较主动固定临时起搏器与传统临时起搏器的安全性及有效性。方法分析2011年1月至2013年6月于北京大学人民医院行电极拔除术的起搏器依赖患者105例,其中2011年1月至2012年12月患者采用传统电生理导管的临时起搏方式,纳入传统临时起搏组,资料为回顾性分析;2013年1月至2013年6月使用主动固定临时起搏,纳入主动固定临时起搏组,资料为前瞻性分析。对比两组间的起搏感知参数、手术时间、并发症及随访2年内的感染复发率和死亡率。结果共纳入105例患者,其中传统临时起搏组70例,主动固定临时起搏组35例。主动固定临时起搏组的起搏阈值[(0.7±0.2)V比(1.0±0.3)V,P=0.035]及临时起搏并发症发生率(0比15.8%,P=0.009)低于传统临时起搏组,差异均有统计学意义。主动固定临时起搏组的临时起搏保留时间[2(2,7)d比2(2,3)d,P=0.032]大于传统临时起搏组,差异有统计学意义。两组患者X线曝光时间与无感染生存率比较,差异均无统计学意义(均P>0.05)。结论相对传统临时起搏,主动固定临时起搏可显著降低临时起搏相关的并发症,延长临时起搏保留时间,增加患者的舒适性,且不增加手术操作时间。

Objective To evaluate the ef f icacy and saf ety of the new active-f itation right ventricular lead temporary-permanent pacemaker（TPPM） rersus the traditional temporary transvenous pacing system.Methods Between January 2011 and June 2013, 234 patients had their inf ected leads removed at our center. A total of 105（44.9%） patients were pacemaker dependent. Thirty-f ive patients underwent TPPM implantation and 70 patients had implanted with traditional temporary transvenous pacing system. For traditional temporary pacing, the quadrupole catheter was implanted into the right ventricle through the f emoral vein to connect the temporary pacemaker. In TPPM, an active-f ixation electrode was implanted into the right ventricular septum through the subclavian and internal jugular veins to connect to the reused permanent pacemaker. parameters f rom the pacemakers,time f or the procedure,the occurance of complications and rates of inf ection and mortality during the 2 years of f ollow up were compared between the 2 groups. Results There were more patients with inf ectious endocarditis in the TPPM group than in the traditional temporary pacing group（22.9% vs. 5.7%, P=0.019）. Theref ore, the electrode retention time in the TPPM group was longer [2（2,7）d vs. 2（2,3） d, P=0.032] and the hospital stay was slightly prolonged [15（14,21）d vs. 17（15,25）d, P =0.05] compared with the traditional temporary pacing group. The pacing threshold in the TPPM group was lower than that in the traditional temporary pacing group [（0.7±0.2） V vs.（1.0±0.3） V,P=0.035）]. There was no difference in X-ray exposure time between the groups [（24.7±15.4） min vs.（27.5±17.7） min, P =0.242]. There were no complications related to bridging in the TPPM group,but 11 patients in the traditional temporary pacing group had developed complications（P=0.009）.Conclusions TPPM is ef f ective and saf er as compared to traditional temporary pacing f or pacemaker-dependent patients with device inf ection. The operation time does not increase in patients with TPPM implantation.