主动导线植入右心耳的改良技术的临床研究

Clinical study on modified technique for permanent atrial pacing in right atrial appendage

目的探讨心房主动导线植入右心耳的改良技术的安全性和有效性,以及与被动导线比较的差别。方法入选2015年5月至2016年3月住院接受心脏起搏器植入的患者191例,其中88例使用改良技术将主动导线植入右心耳(主动组),103例使用被动导线植入右心耳(被动组)。记录手术曝光时间,测试术中的起搏参数,记录并发症。结果所有患者的心房导线均成功植入右心耳。两组手术曝光时间无差异[(6.87±4.02)min vs(6.79±3.82)min,P>0.05]。与被动组比较,主动组感知幅值降低[(2.97±1.39)mV vs(3.69±1.48)mV,P<0.01]、起搏阈值增高[(0.86±0.37)V vs(0.59±0.20)V,P<0.01]和阻抗减小[(513.46±149.91)Ωvs(571.05±159.20)Ω,P<0.05]。主动组未发生术中和术后并发症,被动组有1例导线脱位。结论使用改良技术将心房主动导线植入右心耳操作简便,安全有效。

Objective To investigate the safety and effectiveness in patients with technical modification for perma- nent pacing in right atrial appendage and the differences between active fixation （AF） leads and passive fixation（PF） leads. Methods All patients who underwent successful implantation of permanent pacemakers between May 2015 and March 2016 were analyzed, including 88 cases with AF right atrial leads using the modified technique and 103 cases with PF right atrial leads. X-ray exposure time, parameters of leads implantation and perioperative complica- tions were recorded. Results All leads were successfully implanted in right atrial appendage. X-ray exposure time [（6.87±4.02）min vs （6.79±3.82） min, P〈0.05] was similar between two groups. P wave height and pacing threshold had significant differences between two groups[AF vs PF were （2.97±1.39）mV vs （3.69± 1.48）mV, （0. 86±0.37）V vs （0.59±0.20）V, respectively, P〈0.01]. Impedance of AF group was lower than that of PF group. [（513.46±149.91）Ω vs （571.05±159.20）Ω, P〈0.05]. There were no perioperative complications in AF group. Lead dislodgement was observed in one ease in PF group. Conclusion Using the modified technique,active leads can be fixed in right atrial appendage accurately and rapidly. The modified technique is feasible and safe.