心室无导线起搏器植入部位的初步探讨

Initial studies on the implanting sites of high and low ventricular septum using leadless cardiac pacemaker

目的探讨高位室间隔植入无导线起搏器的可行性和安全性。方法选取本院参与国内首次无导线起搏器临床研究的患者,比较高位室间隔植入无导线起搏器(A组)与低位室间隔植入者(B组)的有关参数。结果共入选15例患者,均顺利植入Micra起搏器。A组8例,B组7例,A组及B组在植入时的起搏阈值[0.38(0.22)mV vs 0.63(1.00)mV]、R波感知[(10.9±4.7) mV vs (7.3±3.0) mV]、电极阻抗[(906.3±162.4)Ωvs (750.0±173.4)Ω]、T波同步导联数[(7.2±2.7) vs (7.1±2.5)]差异均无显著性(P>0.05)。起搏QRS时限A组有缩短的趋势(140.0 ms vs 179.0 ms,P>0.05),A组起搏QTc短于B组(440.0 ms vs 520.0 ms,P<0.05),A组在手术中的透视时间短于B组[12.86(5.36) min vs 18.46(4.41) min,P<0.05]。两组在出院前、随访1个月时的阈值、感知及阻抗差异均无显著性(P>0.05)。结论高位室间隔植入Micra无导线起搏器安全、可行,起搏的心室除极与复极顺序可能优于低位间隔起搏。

Objective To investigate the feasibility and safety of high ventricular septal implantation of leadless pacemaker(Micra).Methods The patients who participated in the first clinical study of Micra in our hospital were selected and the parameters of Micra implanted in high ventricular septum(group A)and low ventricular septum(group B)were compared.Results A total of 15 patients were enrolled,and Micra pacemaker was successfully implanted.There were no significant differences in pacing threshold[0.38(0.22)mV vs 0.63(1.00)mV],R-wave perception[(10.9±4.7)mV vs(7.3±3.0)mV],electrode impedance[(906.3±162.4)Ωvs(750.0±173.4)Ω],T-wave synchronous leads[(7.2±2.7)vs(7.1±2.5)]between group A(n=8)and group B(n=7)at implantation(P>0.05).The pacing QRS time in group A was shorter than that in group B(440.0 msvs 520.0 ms,P<0.05),and the fluoroscopy time in group A was shorter than that in group B(12.86(5.36)min vs 18.46(4.41)min,P<0.05)There was no significant difference in threshold,R perception and impedance between the two groups before discharge and 1 month after follow-up(P>0.05).Conclusion Micra lead-free pacemaker implantation into high ventricular septum is safe and feasible,and the sequence of ventricular depolarization and repolarization may be better than that of low ventricular septum pacing.