无导线起搏器对超高龄患者的可行性和安全性

Feasibility and safety of leadless pacemakers in very elderly patients

目的探讨无导线起搏器对超高龄老年人应用中的可行性及安全性。方法本研究为回顾性非随机队列研究, 连续纳入2019年12月至2022年6月在四川大学华西医院心内科年龄≥85岁植入无导线起搏器患者。分析患者的基线临床资料, 包括合并症、既往手术情况及抗凝和/或抗血小板药物使用情况, 无导线起搏器植入术中记录起搏器程控参数(阈值、R波振幅、阻抗)及手术相关并发症。结果共纳入55例超高龄患者, 男33例, 女22例, 体重指数(BMI)为(23.0±4.4)kg/cm^(2), 年龄(90.1±3.8)岁。植入起搏器适应证:病态窦房结综合征37例, 房室传导阻滞30例。所有患者均成功植入无导线起搏器(Micra), 植入部位均为右心室间隔中部。植入时起搏电学参数:阈值(0.5±0.3)V/0.24 ms、R波振幅(9.3±4.5)mV、阻抗(917.6±354.1)Ω。围术期未出现心脏穿孔、心脏压塞、血管并发症、深静脉血栓、器械移位、器械感染、胸痛、血胸等不良事件。结论在≥85岁超高龄患者中植入无导线起搏器是安全、可行的, 无导线起搏器将为此类患者提供一种可替代经静脉起搏器的治疗方式。

Objective To investigate the feasibility and safety of implanting a leadless pacemaker in the elderly.Methods This study was a retrospective,non-randomized cohort study,patients aged≥85 years with leadless pacemaker implantation in the Department of Cardiology,West China Hospital of Sichuan University from December 2019 to June 2022 were consecutively enrolled.Baseline clinical data,including comorbidities,previous surgery,and use of anticoagulants and/or antiplatelet drugs,were retrospectively analyzed.The pacemaker programmed parameters(threshold,R-wave amplitude,impedance)and surgical complications were recorded during leadless pacemaker(Micra)implantation.Pacing electrical parameters(threshold,R-wave amplitude,impedance)and surgical complications were recorded during leadless pacemaker(Micra)implantation.Results A total of 55 elderly patients were enrolled,including 33 males and 22 in females,with body mass index(BMI)of(23.0±4.4)kg/cm^(2) and an average age of(90.1±3.8)years.Among them,37 patients had sick sinus syndrome and 30 patients had atrioventricular block(AVB).All patients were successfully implanted with a leadless pacemaker(Micra)in the median septum of the right ventricle.The pacing electrical parameters at implantation:pacing threshold(0.5±0.3)V/0.24 ms,R wave amplitude(9.3±4.5)mV,impedance(917.6±354.1)Ω.No adverse events such as cardiac perforation,cardiac tamponade,vascular complications,deep vein thrombosis,device displacement,device infection,chest pain or hemothorax occurred during the perioperative period.Conclusion It is safe and feasible to implant leadless pacemaker in elderly patients≥85 years old,and leadless pacemaker will provide an alternative treatment options for such patients.