心室主动电极体外临时持续起搏的安全性及有效性

Safety and Effectiveness of Extracorporeal Temporary Continuous Pacing With Ventricular Active Electrodes

目的:评价心室主动电极体外临时持续起搏的安全性及有效性。方法:回顾性分析2014年1月至2022年1月于北京大学人民医院因起搏器感染行电极拔除术且起搏器依赖患者共415例,均使用心室主动电极体外桥接临时持续起搏。收集临床资料及随访结果,分析其安全性及有效性。结果:415例患者平均年龄(63.8±11.7)岁,男性315例(75.9%)。局部囊袋感染310例(74.7%),菌血症75例(18.1%),感染性心内膜炎30例(7.2%),病态窦房结综合征185例(44.6%),高度或完全性房室阻滞30例(55.4%)。穿刺点位于同侧锁骨下或腋静脉315例(75.9%),右侧颈内静脉入路100例(24.1%)。405例(97.6%)为右心室间隔部临时起搏,10例(2.4%)由于不耐受单腔起搏模式而选择了右心房+右心室双腔体外临时起搏。临时起搏电极保留时间为(15.3±11.6)d,4例(0.9%)出现与临时起搏相关的并发症。中位随访24.5(7.8,51.3)个月期间,1例(0.3%)患者再次出现起搏器感染。结论:对于起搏器依赖患者在感染装置拔除后,心室主动电极体外临时持续起搏安全、有效,临时起搏相关并发症发生率低。

Objectives:To evaluate the safety and effectiveness of extracorporeal temporary continuous pacing with ventricular active electrodes.Methods:A total of 415 patients with pacemaker dependence after electrode extraction due to pacemaker infection in the Peking University People’s Hospital from January 2014 to January 2022 were included in this retrospective study.Clinical data were analyzed.Results:The mean age was(63.8±11.7)years,and 315 cases(75.9%)were male.There were 310 patients(74.7%)with local pocket infection,75 cases(18.1%)with bacteremia,and 30 cases(7.2%)with infective endocarditis.There were 185patients(44.6%)with sick sinus syndrome and 30 patients(55.4%)with high or complete atrioventricular block.The puncture point was located in the same subclavian or axillary vein in 315 patients(75.9%),and the right internal jugular vein approach was used in 100 patients(24.1%).Temporary pacing was achieved in 405 patients(97.6%)from the right ventricular septum,and 10 cases(2.4%)from the right atrium and right ventricle dual chamber because they could not tolerate the single chamber pacing mode.The retention time of temporary pacing electrodes was(15.3±11.6)d.Complications related to temporary pacing occurred in 4 patients(0.9%).The median follow-up time was 24.5(7.8,51.3)months.One patient(0.3%)developed pacemaker infection again.Conclusions:For pacing dependent patients,extracorporeal temporary continuous pacing with active ventricular electrodes is safe and effective after removal of infected device,and the incidence of temporary pacing related complications is low.