双心腔主动电极起搏与心房被动心室主动电极起搏的对比研究

Application of double active-fixation pacing leads in the dual chamber cardiac pacemaker implantation

目的:观察心房心室双螺旋主动电极在双腔心脏起搏器植入术中的有效性和安全性。方法:回顾性将90例符合双腔起搏器植入指征的患者分为心房心室双螺旋主动电极组(双螺旋电极组42例)与心房被动电极、心室螺旋主动电极组(单螺旋电极组48例)。观察2组术中及术后随访情况。结果:2组均成功植入起搏器及起搏电极。双螺旋电极组中1例孕妇零射线下完成双螺旋电极及起搏器植入;4例永存左上腔静脉患者在左侧锁骨下完成双螺旋电极及起搏器植入。双螺旋电极组和单螺旋电极组的手术时间及射线时间无显著差别,双螺旋电极组术后卧床时间显著缩短[(4.2±1.5)h vs(56.3±22.5)h,P<0.05]。单螺旋电极组术中出现心房电极导线脱位3例,双螺旋电极组未见导线移位、心肌穿孔及心包填塞等情况。术后随访,2组均无电极脱落和起搏阈值升高。结论:心房心室双螺旋主动电极在双腔心脏起搏器植入术中安全可行,并不增加手术时间和射线时间,特别是应用于心腔结构异常和特殊患者,显著增加手术成功率。

Objective:To investigate the efficacy and safety of the double active-fixation pacing leads in the dual chamber cardiac permanent pacemaker implantation(PPI).Methods:A total of 90 consecutive patients were retrospectively divided into two groups for dual chamber cardiac pacemaker implantation with double active-fixation pacing leads(42 cases)versus atrial J-shaped passive fixation lead and ventricular active-fixation pacing lead(48 cases).The success rate,procedure time,fluoroscopic time and complications were assessed.Results:Pacemakers were implanted successfully in all patients of two groups.In the double active-fixation leads group,1 pregnant woman underwent PPI without guiding by X-ray,and 4 patients with persistent left superior vena cava underwent PPI in the left subclavian region.Procedure time,fluoroscopy time and complications had no significant difference between two groups.The bed rest time was significantly shorter in the double active-fixation pacing leads group than in the single active-fixation lead group[(4.2±1.5)h vs(56.3±22.5)h,P<0.05].In the single active-fixation lead group,atrial lead dislodgement occurred in 3 patients during the procedure.No lead dislodgement,myocardium perforation and pericardial tamponade occurred in the double active-fixation leads groups.The pacing thresholds did not differ between two groups during the follow-up period.Conclusions:Application of double active-fixation pacing leads in the dual chamber cardiac pacemaker implantation is safe and feasible,particular to the patients with congenital anomaly and pregnant woman.It can provide selective pacing without prolonging procedure time and fluoroscopy time,and shorten the bed rest time significantly.