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目的探索伴有右心耳切除术的患者起搏器植入术中使用心房主动固定电极导线的长期适应性和稳定性。方法入选85例病窦综合征或Ⅱ度或高度房室传导阻滞的患者并且分为,切除组(n=22)行右心耳切除术且植入双腔起搏器,保留组(n=63)未行心外科手术即右心耳保留患者行双腔起搏器。分别于植入时(0天)、1天;3、6、12、24和36个月进行起搏参数测定(起搏阈值、P/R振幅和阻抗)、植入时以及每年一次X线摄片、心脏超声检查以及电极导线植入术中和术后起搏器相关并发症的随访。结果所有电极导线植入位置均保持稳定。两组患者心房、心室电极导线的初始感知灵敏度相当(P>0.05)且长期保持稳定。从植入术时至1个月,电极导线阻抗轻微下降(前后比较,P>0.05),且随后保持稳定。心房电极导线的起搏阈值从植入时至术后3个月随访时有降低趋势(P>0.05),在随后的随访中保持稳定,心室起搏电极导线的起搏阈值在随访全程中保持稳定,且两组间不存在显著性差异(P>0.05)。但两组术前术后自身比较可见左、右心房直径、左室舒张/收缩末内径有缩小,射血分数值有一定降低,但均无显著性差异(P>0.05)。随访全程两组患者未发现电极导线穿孔、移位等起搏器相关并发症发生。结论心房主动固定电极导线可成功地植入到行右心耳切除术后患者的心耳基底部,在长期随访中起搏器电极导线参数满意且保持稳定。
Objective To explore the long-term adaptability and stability of atrial active fixation leads in patients undergoing atrial pacemaker implantation with right atrial appendicitis. Methods Eighty-five patients with sick sinus syndrome or grade II or height atrioventricular block were enrolled and divided into two groups: right aurotomy in the resection group (n = 22) and implantation of a double-chamber pacemaker in the retention group (n = 63) left uninvited surgery that is, right atrial appendage retained patients with double-chamber pacemaker. The pacing parameters (pacing threshold, P / R amplitude and impedance) at implantation (day 0, day 1, day 3, 6, 12, 24 and 36) Radiography, echocardiography and follow-up of complications associated with postoperative pacemaker implantation. Results All electrode leads were stable. The initial sensory sensitivity of atrial and ventricular lead in both groups was comparable (P> 0.05) and stable in the long term. From the time of implantation to 1 month, the electrode lead resistance decreased slightly (before and after comparison, P> 0.05) and then remained stable. The pacing threshold of the atrial lead was decreased from the time of implantation to 3 months after operation (P> 0.05), and remained stable at subsequent follow-up. The pacing threshold of ventricular pacing lead was maintained during the follow-up Stable, and there was no significant difference between the two groups (P> 0.05). However, the left and right atrial diameter, left ventricular end-diastolic / end-systolic diameter were reduced and the ejection fraction was decreased, but no significant difference (P> 0.05). Follow-up of the two groups of patients found no electrode lead perforation, displacement and other complications related to pacemaker. Conclusions Atrial active fixed electrode leads can be successfully implanted in the atrial appendage of patients after right atrial appendicitis. The parameters of pacemaker electrode leads are satisfactory and stable in long term follow-up.