Summary： Lead placement for ventricular pacing variably impacts the physiological benefit of the pa- tient. This study evaluated the ventricular lead performance and safety of right ventricular outflow tract septal p...Summary： Lead placement for ventricular pacing variably impacts the physiological benefit of the pa- tient. This study evaluated the ventricular lead performance and safety of right ventricular outflow tract septal pacing in patients with bradyarrhythmia in South China over 60-month follow-up. Totally, 192 patients （108 males, and 84 females, 63-4-21 years old） with bradyarrhythmia were randomly divided into two groups. The right ventricular outflow tract septum （RVOTs） group had lead placement near the sep- tum （n=97）, while the right ventricular apex （RVA） group had a traditional apical placement （n=95）. RV septal lead positioning was achieved with a specialized stylet and confirmed using fluoroscopic projec- tion. All patients were followed up for 60 months. Follow-up assessment included stimulation threshold, R-wave sensing, lead impedance and lead complications. The time of electrode implantation in both the ROVTs and RVA groups were significantly different （4.29±0.61 vs. 2.16±0.22 min; P=0.009）. No dif- ferences were identified in threshold, impedance or R-wave sensing between the two groups at 1 st, 12th, 36th and 60th month during the follow-up period. No occurrence of electrode displacement, increased pacing threshold or inadequate sensing was found. The long-term active fixation ventricular electrode performance in RVOTs group was similar to that in RVA group. RVOTs pacing near the septum using active fixation electrodes may provide stability during long-term follow-up period.展开更多
Current permanent right ventricular and right atrial endocardial pacing leads are implanted utilizing a central lumen stylet. Right ventricular apex pacing initiates an abnormal asynchronous electrical activation patt...Current permanent right ventricular and right atrial endocardial pacing leads are implanted utilizing a central lumen stylet. Right ventricular apex pacing initiates an abnormal asynchronous electrical activation pattern, which results in asynchronous ventricular contraction and relaxation. When pacing from right atrial appendage, the conduction time between two atria will be prolonged, which results in heterogeneity for both depolarization and repolarization. Six patients with Class Ⅰ indication for permanent pacing were implanted with either single chamber or dual chamber pacemaker. The SelectSecure 3830 4-French （Fr） lumenless lead and the SelectSite C304 8.5-Fr steerable catheter-sheath （Medtronic Inc., USA） were used. Pre-selected pacing sites included inter-atrial septum and right ventricular outflow tract, which were defined by ECG and fluoroscopic criteria. All the implanting procedures were successful without complication. Testing results （mean atrial pacing threshold： 0.87 V; mean P wave amplitude： 2.28 mV; mean ventricular pacing threshold： 0.53V; mean R wave amplitude： 8.75 mV） were satisfactory. It is concluded that implantation of a 4-Fr lumenless pacing lead by using a streerable catheter-sheath to achieve inter-atrial septum or right ventricular outflow tract pacing is safe and feasible.展开更多
目的评价中位右室间隔起搏(RVSP)方法的可行性和安全性。方法选择101例行RVSP,右室心尖部起搏(RVAP)126例作对照。在X线指导下将室间隔分四区,分别为His束区、右室流出道间隔区、低位前间隔区和右室流入道间隔区,精确定位RVSP的主动导...目的评价中位右室间隔起搏(RVSP)方法的可行性和安全性。方法选择101例行RVSP,右室心尖部起搏(RVAP)126例作对照。在X线指导下将室间隔分四区,分别为His束区、右室流出道间隔区、低位前间隔区和右室流入道间隔区,精确定位RVSP的主动导线在中位间隔位置。记录术中曝光时间、电极导线植入参数、心电图和术后第3,6,12个月随访资料。结果两组手术曝光时间无差异。RVSP组起搏前后的QRS波形态有稳定的特征性变化,可结合X线用于指导导线定位。RVSP组起搏后的QRS波时限明显小于RVAP组(98.19±22.30 msvs 120.80±24.14 ms,P<0.01),术中两组的心室导线的起搏阈值、电流、阻抗均存在明显差异(0.76±0.30 V vs0.39±0.10 V,0.98±0.52 mA vs 0.36±0.19 mA,690.67±141.64Ωvs 867.16±201.23Ω,P<0.01)。在随访中两组心室起搏阈值和阻抗较稳定。结论在X线指导下将室间隔分区,主动导线能精确、快捷地固定于右室中位间隔部。该部位是较理想的起搏部位,安全可行。展开更多
目的介绍主动固定螺旋电极在右室流出道间隔部起搏中的应用经验。方法86例起搏适应证患者随机分成两组,一组42例采用主动固定螺旋电极行右室流出道室间隔起搏(简称主动电极组),另一组44例应用被动固定电极行右室心尖起搏(简称被动电极...目的介绍主动固定螺旋电极在右室流出道间隔部起搏中的应用经验。方法86例起搏适应证患者随机分成两组,一组42例采用主动固定螺旋电极行右室流出道室间隔起搏(简称主动电极组),另一组44例应用被动固定电极行右室心尖起搏(简称被动电极组),观察两组有关手术指标及主动电极组的起搏参数。结果主动电极组电极操作时间长于被动电极组(18.4±7.7 min vs 16.6±6.5 min,P<0.05),起搏QRS波时限则明显短于被动电极组(0.138±0.046 s vs 0.162±0.020 s,P<0.01);主动固定螺旋电极植入后起搏阈值达高峰,15 min后即降至稳定水平(0.78±0.26 Vvs 0.54±0.27 V,P<0.05);主动电极组1例发生电极脱位。结论主动固定螺旋电极在右室流出道室间隔起搏中是可行的、安全的,植入方法是关键。展开更多
目的 比较右室主动固定电极和被动电极导线应用结果，探索右室主动固定电极导线临床应用的可行性。方法 需要安置心脏起搏器患者59例，其中男20例、女39例；年龄在75．6±23．8（54-92）岁。患者为缓慢性心律失常或者严重心力衰竭...目的 比较右室主动固定电极和被动电极导线应用结果，探索右室主动固定电极导线临床应用的可行性。方法 需要安置心脏起搏器患者59例，其中男20例、女39例；年龄在75．6±23．8（54-92）岁。患者为缓慢性心律失常或者严重心力衰竭。30例被动电极组，固定部位为右室心尖部；主动电极组29例，电极固定部位为右室流出道。结果 主动电极组与被动电极组即刻起搏参数比较没有明显的差异（起搏阈值：0．62±0．19V vs 0．78±0．09V，P〉0．05）。在出院后1，3，6个月随访起搏阈值与置入时比较也没有差异。只有1例出现主动电极从右室流出道间隔部脱位。主动电极置入时间和曝光时间较被动电极明显延长（45．03±1．99min vs 13．69±11．37min；17．88±7．23min vs 89．78±3．55min，P均〈0．05）。结论 使用主动固定电极进行右室流出道间隔部起搏是可行和安全的。展开更多
基金supported in part by grants from the Science and Technology Key Foundation of Guangdong Province(No.2010B031600166)the Science and Technology Foundation of Guangdong Province(No.2011B061300072)
文摘Summary： Lead placement for ventricular pacing variably impacts the physiological benefit of the pa- tient. This study evaluated the ventricular lead performance and safety of right ventricular outflow tract septal pacing in patients with bradyarrhythmia in South China over 60-month follow-up. Totally, 192 patients （108 males, and 84 females, 63-4-21 years old） with bradyarrhythmia were randomly divided into two groups. The right ventricular outflow tract septum （RVOTs） group had lead placement near the sep- tum （n=97）, while the right ventricular apex （RVA） group had a traditional apical placement （n=95）. RV septal lead positioning was achieved with a specialized stylet and confirmed using fluoroscopic projec- tion. All patients were followed up for 60 months. Follow-up assessment included stimulation threshold, R-wave sensing, lead impedance and lead complications. The time of electrode implantation in both the ROVTs and RVA groups were significantly different （4.29±0.61 vs. 2.16±0.22 min; P=0.009）. No dif- ferences were identified in threshold, impedance or R-wave sensing between the two groups at 1 st, 12th, 36th and 60th month during the follow-up period. No occurrence of electrode displacement, increased pacing threshold or inadequate sensing was found. The long-term active fixation ventricular electrode performance in RVOTs group was similar to that in RVA group. RVOTs pacing near the septum using active fixation electrodes may provide stability during long-term follow-up period.
基金supported by a grant form a Program of Science and Technology Development of Hubei Province (2004AA304B09).
文摘Current permanent right ventricular and right atrial endocardial pacing leads are implanted utilizing a central lumen stylet. Right ventricular apex pacing initiates an abnormal asynchronous electrical activation pattern, which results in asynchronous ventricular contraction and relaxation. When pacing from right atrial appendage, the conduction time between two atria will be prolonged, which results in heterogeneity for both depolarization and repolarization. Six patients with Class Ⅰ indication for permanent pacing were implanted with either single chamber or dual chamber pacemaker. The SelectSecure 3830 4-French （Fr） lumenless lead and the SelectSite C304 8.5-Fr steerable catheter-sheath （Medtronic Inc., USA） were used. Pre-selected pacing sites included inter-atrial septum and right ventricular outflow tract, which were defined by ECG and fluoroscopic criteria. All the implanting procedures were successful without complication. Testing results （mean atrial pacing threshold： 0.87 V; mean P wave amplitude： 2.28 mV; mean ventricular pacing threshold： 0.53V; mean R wave amplitude： 8.75 mV） were satisfactory. It is concluded that implantation of a 4-Fr lumenless pacing lead by using a streerable catheter-sheath to achieve inter-atrial septum or right ventricular outflow tract pacing is safe and feasible.
文摘目的评价中位右室间隔起搏(RVSP)方法的可行性和安全性。方法选择101例行RVSP,右室心尖部起搏(RVAP)126例作对照。在X线指导下将室间隔分四区,分别为His束区、右室流出道间隔区、低位前间隔区和右室流入道间隔区,精确定位RVSP的主动导线在中位间隔位置。记录术中曝光时间、电极导线植入参数、心电图和术后第3,6,12个月随访资料。结果两组手术曝光时间无差异。RVSP组起搏前后的QRS波形态有稳定的特征性变化,可结合X线用于指导导线定位。RVSP组起搏后的QRS波时限明显小于RVAP组(98.19±22.30 msvs 120.80±24.14 ms,P<0.01),术中两组的心室导线的起搏阈值、电流、阻抗均存在明显差异(0.76±0.30 V vs0.39±0.10 V,0.98±0.52 mA vs 0.36±0.19 mA,690.67±141.64Ωvs 867.16±201.23Ω,P<0.01)。在随访中两组心室起搏阈值和阻抗较稳定。结论在X线指导下将室间隔分区,主动导线能精确、快捷地固定于右室中位间隔部。该部位是较理想的起搏部位,安全可行。
文摘目的介绍主动固定螺旋电极在右室流出道间隔部起搏中的应用经验。方法86例起搏适应证患者随机分成两组,一组42例采用主动固定螺旋电极行右室流出道室间隔起搏(简称主动电极组),另一组44例应用被动固定电极行右室心尖起搏(简称被动电极组),观察两组有关手术指标及主动电极组的起搏参数。结果主动电极组电极操作时间长于被动电极组(18.4±7.7 min vs 16.6±6.5 min,P<0.05),起搏QRS波时限则明显短于被动电极组(0.138±0.046 s vs 0.162±0.020 s,P<0.01);主动固定螺旋电极植入后起搏阈值达高峰,15 min后即降至稳定水平(0.78±0.26 Vvs 0.54±0.27 V,P<0.05);主动电极组1例发生电极脱位。结论主动固定螺旋电极在右室流出道室间隔起搏中是可行的、安全的,植入方法是关键。
文摘目的 比较右室主动固定电极和被动电极导线应用结果，探索右室主动固定电极导线临床应用的可行性。方法 需要安置心脏起搏器患者59例，其中男20例、女39例；年龄在75．6±23．8（54-92）岁。患者为缓慢性心律失常或者严重心力衰竭。30例被动电极组，固定部位为右室心尖部；主动电极组29例，电极固定部位为右室流出道。结果 主动电极组与被动电极组即刻起搏参数比较没有明显的差异（起搏阈值：0．62±0．19V vs 0．78±0．09V，P〉0．05）。在出院后1，3，6个月随访起搏阈值与置入时比较也没有差异。只有1例出现主动电极从右室流出道间隔部脱位。主动电极置入时间和曝光时间较被动电极明显延长（45．03±1．99min vs 13．69±11．37min；17．88±7．23min vs 89．78±3．55min，P均〈0．05）。结论 使用主动固定电极进行右室流出道间隔部起搏是可行和安全的。
