无导线心脏起搏器的研究进展

传统经静脉起搏器(transvenous pacemaker,TVP)挽救了万千患者生命,改善了患者的生活质量,但由起搏器装置所带来的相关并发症也给患者带来痛苦。无导线心脏起搏器(leadless cardiac pacemaker,LCP)的诞生解除了传统经静脉起搏器电极导线及囊袋所带来的并发症,但它的临床应用目前还处于初级阶段,尚存在许多未知和挑战。本综述将进一步介绍无导线心脏起搏器的来源和种类、安全性和临床性能,心脏植入电子装置感染后植入无导线心脏起搏器的应用,无导线心脏起搏器功能终止的管理以及无导线心脏起搏器的未来发展。

Micra无导线起搏器的临床应用进展

无导线起搏器作为缓慢性心律失常治疗领域的新星,已经在临床试验中得到了广泛关注与研究。其中,Micra是目前国内唯一使用的无导线心脏起搏器,其应用消除了与传统经静脉起搏导线和皮下囊袋相关并发症,减少了锁骨下静脉穿刺可能引发的血胸、气胸等相关并发症,但其使用存在较高的心包积液/穿孔风险。对于高危及特殊人群,无导线起搏器同样展现出了其可行性和安全性。此外,与传统的经静脉起搏器相比,亦显著提升患者的生活质量。本文结合近年来的相关研究报道,现就无导线心脏起搏器的技术进展、安全性和有效性研究、优势、与多种起搏方式的联合应用、挑战与展望等方面做一综述。As a rising star in the field of bradycardia treatment, leadless pacemakers have attracted significant attention and been tested in clinical trials. Among the leadless pacemakers, Micra is currently the only one used domestically. Its application eliminated complications associated with traditional transvenous pacing leads and subcutaneous pockets, and reduced the risk of hemothorax, pneumothorax, and other related complications that may be caused by subclavian vein puncture. However, there is a higher risk of pericardial effusion/perforation in the application of Micra. For high-risk and special patient populations, leadless pacemakers have also showed demonstrable feasibility and safety. Moreover, compared with traditional transvenous pacemaker, leadless pacemakers significantly improve patients’ quality of life. This article combines relevant research reports in recent years to provide a comprehensive review of the technological advancements, safety and effectiveness studies, advantages, combined applications with various pacing methods, challenges, and the future of leadless cardiac pacemakers.

无导线心脏起搏器和传统心脏起搏器术后并发症的荟萃分析

目的比较无导线心脏起搏器和传统心脏起搏器术后并发症。方法计算机检索PubMed、Embase、Google Scholar、The Cochrane Library、Clinical Trials、中国知网、万方数据库,搜索无导线起搏器和传统起搏器植入的对照研究,检索时限均从建库至2020年2月。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险,采用RevMan 5.3进行荟萃分析。结果最终纳入5个研究,共2913例患者,其中无导线心脏起搏器组(无导线组)1091例,传统心脏起搏器组(传统组)1822例。荟萃分析显示,与传统组比较,无导线组感染性心内膜炎发生率较低(OR=0.07,95%CI:0.01~0.52,P<0.05),而血管并发症发生率较高(OR=4.55,95%CI:1.90~10.89,P<0.01)。两组在三尖瓣损伤/功能障碍、起搏电极脱位、心包积液/穿孔、感染等方面的差异无统计学意义(P≥0.05)。结论与传统起搏器植入术相比,无导线心脏起搏器术后感染性心内膜炎少而血管并发症多。