无导线起搏器植入术后急性期心肌损伤的单中心观察性研究

A single-center observational study of acute myocardial injury after leadless pacemaker implantation

目的观察无导线起搏器植入术后急性期(48 h内)心肌损伤标志物水平的变化情况,并探讨其与固定翼释放次数的相关性。方法采用单中心前瞻性非随机队列研究方法,连续纳入新疆医科大学第一附属医院心脏中心起搏电生理科2021年8月至12月植入无导线起搏器组(A组)及双腔起搏器组(B组)患者,根据无导线起搏器术中固定翼释放次数将A组分为释放1次(A1组)和释放≥2次(A2组)。收集患者术前24 h至术后0、4、8、12、24、48 h血液样本,分别对比A、B组间及A1、A2组间血浆肌酸激酶同工酶(CK-MB)、肌红蛋白(MYO)、肌酸激酶(CK)及肌钙蛋白(cTnI)等心肌损伤标志物水平的变化。结果共纳入140例患者,其中无导线起搏器组60例(男41例),年龄(70.75±11.77)岁,年龄范围36~91岁;双腔起搏器组80例(男47例),年龄(70.54±9.90)岁,年龄范围45~87岁。术后A、B组所有患者术前24 h至术后48 h心肌损伤标志物含量均呈现上升后下降的趋势,与术前相比差异有统计学意义(P<0.001)。至术后48 h,A1组(40例)患者血浆cTnI表达水平与术前相比差异有统计学意义(P<0.001)。其次,A组患者CK-MB、CK、cTnI术后水平高于B组,差异具有统计学意义(P<0.001);A2组(20例)患者CK-MB、CK、cTnI术后水平高于A1组,差异具有统计学意义(均P<0.05)。结论无导线起搏器植入术后急性期(48 h内)心肌损伤标志物水平呈现上升后下降的趋势,且升高程度与无导线起搏器固定翼释放次数相关。

Objective To observe the changes of myocardial injury markers within 48 hours after leadless pacemaker(Micra)implantation,and to explore its correlation with the frequency of fixed wing release.Methods A single-center prospective non-randomized cohort study was conducted.Consecutive patients implanted with Micra(group A)and dual chamber pacemaker(group B)in Department of Pacing and Electrophysiology,The First Affiliated Hospital of Xinjiang Medical University from August 2021 to December 2021 were enrolled.According to the frequency of fixed wing release during leadless pacemaker operation,group A was divided into release once(group A1)and release≥2 times(group A2).Blood samples were collected from 24 h before operation to 0,4,8,12,24,48 h after operation.The levels of creatine kinase isoenzyme(CK-MB),myoglobin(MYO),creatine kinase(CK)and cardiac troponinⅠ(cTnI)were compared between groups A and B and between groups A1 and A2.Results A total of 140 patients were enrolled,including 60 patients(male 41)with leadless pacemaker,aged(70.75±11.77)years,aged from 36 to 91 years,and 80 patients(male 47)with dual chamber pacemaker,aged(70.54±9.90)years,the age range is 45 to 87 years.The levels of myocardial injury markers in all patients in group A and B showed a trend of increase and then decrease from 24 h before operation to 48 h after operation,which was statistically significant compared with that before operation(P<0.001).Up to 48 hours after operation,the plasma cTnI level in group A1(n=40)was still statistically different from that before operation(P<0.001).Secondly,the expression levels of CK-MB,CK,cTnI and other myocardial injury markers in group A were higher than that in group B after operation,and the differences were statistically significant(P<0.001).The expression levels of CK-MB,CK,cTnI and other myocardial injury markers in group A2(n=20)were higher than that in A1 group after operation,and the differences were statistically significant(all P<0.05).Conclusion The level of myocardial injury markers increased and then decreased within 48 hours after Micra implantation,and the degree of increase was related to the frequency of fixed wing release of Micra.