超高龄患者植入无导线起搏器的安全性初探

Safety of leadless pacemaker implantation in super-elderly patients

目的探讨超高龄患者植入无导线起搏器的安全性。方法该研究为纵向研究。纳入2021年3月至2022年5月于北京大学人民医院心内科行无导线起搏器植入的超高龄(年龄≥85岁)患者。通过电子病历系统收集入选者的一般临床资料,通过影像系统和程序控制系统记录入选者X线曝光量和无导线起搏器相关电学参数,通过手术记录查询入选者手术时间及围术期并发症情况。于术后24 h、3 d以及1、3和6个月对患者进行随访,评估有无心包填塞、心肌梗死、脑梗死、肺栓塞、起搏器再感染、死亡和股静脉血肿等并发症。结果最终入选患者11例,年龄90(86,92)岁,男性9例。其中,因房室传导阻滞植入起搏器者4例、因病态窦房结综合征植入起搏器者3例、因心房颤动伴长间歇植入起搏器者4例;合并高血压者9例、糖尿病者9例、冠心病者9例、慢性肾病者6例、慢性阻塞性肺病者4例、陈旧性脑梗死者4例、中重度三尖瓣反流者4例。11例患者的左心室射血分数为49%(45%,52%),血红蛋白浓度为118(114,122)g/L,其中4例患者服用抗凝药,6例患者服用抗血小板药。11例患者中新植入无导线起搏器者8例,拔除后再植入者2例,拔除同时植入者1例;无导线起搏器植入时间45(40,47)min,X线曝光时间14(13,15)min,释放1(1,2)次,阈值0.50(0.38,0.75)V/0.24 ms,阻抗730(700,770)Ω,感知的R波振幅8.2(6.7,12.8)mV。围术期无人发生心包填塞、心肌梗死、脑梗死、肺栓塞、起搏器再感染,仅1例患者发生股静脉穿刺后血肿,经加压包扎后好转。随访8(6,10)个月,期间无人发生起搏器功能障碍,阈值、感知及阻抗均稳定且维持在正常范围,无人发生起搏器再感染,无人发生心包填塞、心肌梗死、脑梗死、肺栓塞和死亡。结论超高龄患者植入无导线起搏器可能是安全的。

Objective To evaluate the safety of leadless pacemaker implantation in super-elderly patients.Methods Eleven patients with average age of 90(86,92)years who underwent leadless pacemaker implantation in the Department of Cardiology,Peking University People′s Hospital from March 2021 to May 2022 were included.The clinical data and implantation information were collected.The complications(cardiac tamponade,myocardial infarction,cerebral infarction,pulmonary embolism,pacemaker reinfection,femoral vein hematoma)and death of patients were documented at 24 h,3 d,and 1,3,6 months after pacemaker implantation.Results There were 9 males and 2 females with the body mass index of 21(19,23)kg/m2.The underlying diseases were hypertension,diabetes,coronary heart disease,chronic kidney disease,chronic obstructive pulmonary disease,previous cerebral infarction and moderate to severe tricuspid regurgitation in 9,9,9,6,4,4,4 patients,respectively.The left ventricular ejection fraction was 49%(45%,52%),the hemoglobin concentration was 118(114,122)g/L,4 patients were taking anticoagulant drugs,and 6 patients were taking antiplatelet drugs.Eight patients were newly implanted with a leadless pacemaker,2 patients were implanted after removal the old ones,and 1 case was implanted at the same time as removal.The implantation time was 45(40,47)minutes,the X-ray exposure time was 14(13,15)minutes,the release time was 1(1,2),the threshold value was 0.50(0.38,0.75)V/0.24 ms,the impedance was 730(700,770)Ω,and the perceived R-wave amplitude 8.2(6.7,12.8)mV.During the follow-up period of 8(6,10)months,no patient had pacemaker dysfunction;and the threshold,R wave sensing,and impedance were stable and maintained within the normal range.No cardiac tamponade,myocardial infarction,cerebral infarction,pulmonary embolism,pacemaker reinfection or death occurred perioperatively and during the follow-up period;1 patient had hematoma after femoral vein puncture,which improved after compression treatment.Conclusion This single-center and small-sample study shows that leadless pacemaker implantation is safe for super-elderly patients.