论文部分内容阅读
目的:探究右心室造影对无导线起搏器植入位置的指引作用，评价植入后的安全性和有效性，比较与传统单腔起搏器植入术式的优劣。方法:本研究为前瞻性、观察性研究，选择2019年12月至2020年12月期间新疆医科大学第一附属医院60例行无导线起搏器植入的患者，根据无导线起搏器是否在释放前行右心室造影分为造影组及非造影组，并均于术后行心脏三维重建CT，比较无导线起搏器释放的部位差异。随访期间收集起搏器植入术中、术后的阈值、感知、阻抗等参数和不良事件发生情况；与传统单腔起搏器植入术比较手术时间、曝光量等。结果:60例符合适应证的患者均成功植入无导线起搏器（Micra，美国美敦力公司）。造影组40例，非造影组20例，最后均通过心脏三维重建CT确定无导线起搏器的植入部位。非造影组中11例（55.0%，11/20）的患者植入低位间隔，造影组中33例（33/40，82.5%）患者植入中位间隔，差异具有统计学意义（n P<0.05）。平均随访（105±30）d，阈值、感知随时间推移逐渐趋于稳定，阻抗进一步下降1个月后逐渐趋于稳定。除1例患者术区发生轻微血肿外，其余患者无植入器械相关并发症发生。前10例无导线起搏器植入手术时间[（60.00±9.28）min]、X线曝光时间[（14.90±2.28）min]、X线曝光量[（902.50±150.94）mGy]均明显高于同时期传统起搏器植入术，差异有统计学意义（n P<0.05）。随着术者熟练程度的增加，上述指标逐渐缩短并趋于稳定。后20例无导线起搏器与传统起搏器手术时间、X线曝光时间差异无统计学意义，但X线曝光量明显大于传统起搏器，差异具有统计学意义[（564.00±115.90）mGy对（65.25±19.94）mGy，n P<0.05）。n 结论:本研究发现通过右心室造影可以增加无导线起搏器的精准定位。早期随访临床应用安全、有效。与传统单腔起搏器植入术式比较，虽曝光量增加，但手术更加微创，安全性更优。“,”Objective:To assess the guiding role of right ventriculography in the placement of leadless pacemaker. To evaluate the safety and efficacy of leadless pacemaker and to compare the advantages and disadvantages with traditional single-chamber pacemaker.Methods:In this prospective and observational study, a total of 60 patients with Micra leadless pacemaker implantation from December 2019 to December 2020 in The First Affiliated Hospital of Xinjiang Medical University were divided into right ventriculography group (40 cases) and non-right ventriculography group (20 cases) . All the cases were verified by the cardiac three-dimensional reconstruction CT scan. The pacemaker threshold, sensing amplitude, impedance and adverse events were collected, and the operation time and radiation exposure were compared with the traditional single chamber pacemaker.Results:Micra leadless pacemakers were successfully implanted in all the 60 patients with indications. In the ventriculography group, there were 33 cases (82.5%) in the middle septum. In the non-ventriculography group, there were 11 cases (55.0%) in the low septum. There was statistical significance (n P<0.05) in the septum rate between the two groups. During the follow-up period, threshold and impedance were decreased, sensing amplitude was increased. Except for one patient had hematoma in the operative area, there were no implantation-related complications in the other patients. There were no adverse events during the follow-up period. The average threshold and impedance were decreased, sensing amplitude was increased. The operation time [ (60.00±9.28) min] , radiation time [ (14.90±2.28) min] , and radiation exposure dose [ (902.50±150.94) mGy] in the first 10 cases were higher than that in traditional pacemaker implantation. However, the operation and radiation time was decreased in the last 20 cases with exception of sustained higher radiation exposure dose [ (564.00±115.90) mGy vs. (62.25±19.94) mGy] .n Conclusion:Right ventriculography maybe an innovative and valid method to guide leadless pacemaker to the optimal pacing site. The early clinical application of leadless pacemaker is safe and effective, the operation is more minimally invasive, it has more advantages compared with traditional single-chamber pacemaker except for radiation exposure dose increases.