房颤状态下应用X线影像定位植入心房电极的随访

Follow up radiography guided atrial leads implantation during atrial fibrillation

目的 在永久起搏器心房电极的植入过程中 ,某些患者心房处于房颤状态。此时仅能通过X线下心房电极的位置确定心房电极植入是否成功。本研究对此类患者术后心房电极的状态进行随访 ,以揭示此种方法的安全可靠性。方法 对植入心房电极过程中心房处于房颤状态的患者进行术后随访 6～ 72个月。记录常规 12导联心电图 ,部分患者记录心房腔内心电图 ,1例患者记录食管心电图。对维持窦性心律的患者 ,测定心房电极的阻抗、感知以及脉宽设定为 0 .37～ 0 .4 0ms时的阈电压。超声心动图测量的左心房、心室的内径和EF值。结果 39例患者心房电极植入中心房处于房颤状态。对 2 7例患者进行了随访。维持窦性心律者 14例 (5 1.9% ) ,心房静止 1例 (3.7% ) ,心房颤动 12例 (4 4 .4 % )。 14例维持窦性心律者心房电极起搏感知参数良好。比较窦律与心房颤动、静止者的左房内径 (37.3± 4 .95 )mmvs (4 2 .9± 5 .6 2 )mm ,左室舒张末内径 (4 8.7± 4 .6 2 )mmvs (5 3.92± 8.2 3)mm ;左室射血分数 (6 7± 6 .8) %vs (5 1± 14 .9) %均有显著差异P≤ 0 .0 5。结论 起搏器植入术中心房如处于房颤状态 ,以X线透视下心房电极达到良好的部位作为心房电极放置成功的标准是安全可靠的方法。为使术后心房电极持续发挥作用 。

Objective Radiography was used to localize the position of atrial leads in the patients during atrial fibrillation. The purpose of this study is to evaluate the safety and efficiency of this manner. Methods Tweleve leads ECG, intra-atrial and esophageal cardiac electrogram were recorded as follow up in the patients from 6 to 72 months after implanting atrial leads. Using PSA, we measured the impedance, sensing and pacing threshold (pulse duration 0.37-0.40 ms) of the atrial leads in patients with sinus rhythm. Left atrial diameter, left ventricular diameter and EF in the operation were measured. Results 27 in 39 patients with atrial lead implantation during atrial fibrilation were followed up, in which 14 cases (51.9%) were with in sinus rhythm, 1 case (3.7%) with atrial silent and 12 cases (44.4%) with atrial fibrillation. The impedance, sensing and pacing threshold of the atrial leads in the patients with sinus rhythm showed satisfied sensing and pacing. The left atrial diameter, left ventricular diameter and EF in sinus rhythm group and atrial fibrillation, arrest group were (37.3±4.95) mm vs (42.9± 5.62) mm; (48.7±4.62) mm vs (53.92±8.23) mm; (67±6.8)% vs (51±14.9)%. There was a significant difference between the two groups (P<0.05). Conclusion Radiography is a safe and efficient technique to localize the position of atrial leads in the patients with atrial fibrillation during and after the implantation. In order to improve the efficiency of artial lead, left atrial diameter, left ventricular diameter and left ventricular EF should be considered when choosing candidate for atrial lead implantation.