主动电极在超高龄患者永久心脏起搏治疗中的应用
|
摘要
目的观察主动心脏起搏电极在超高龄(≥90岁)患者中的应用特点。方法回顾性分析13例超高龄患者右房及右室心尖部主动起搏电极的使用情况,手术相关并发症的发生,如心肌穿孔、电极脱位、囊袋血肿或感染、术后心、肾功能变化等,以及术中即刻、术后1个月起搏参数的变化特点。结果术后1例患者心功能不全加重,其他患者无相关并发症发生;术后1个月随访起搏电极的阈值及阻抗低于术中即刻,差异有统计学意义(P<0.05)。结论主动电极在超高龄患者心脏起搏治疗中有效、安全,术中起搏阈值和阻抗明显升高,术后1个月逐渐下降。
Objective To investigate the characteristics of active-fixation pacing leads used among elderly patients over 90 years old. Methods The incidence of postoperative complications of 13 patients over 90 years old was observed, including myocardial perforation, electrode dislocation, pocket hematoma or infection, and postoperative cardiac or renal function. Electrode pacing parameters upon operation and 1 month after operation were recorded and analyzed. Results One case suffered from deteriorating cardiac function. No other complications were observed. The electrode pacing threshold value and impedance one month after operation were significantly lower than those upon operation(P<0.05). Conclusion Application of active-fixation pacing leads in extreme elderly patients is effective and safe. The pacing threshold value and impedance of active-fixation leads tend to increase perioperatively, but decrease gradually one month after operation.
Objective To investigate the characteristics of active-fixation pacing leads used among elderly patients over 90 years old. Methods The incidence of postoperative complications of 13 patients over 90 years old was observed, including myocardial perforation, electrode dislocation, pocket hematoma or infection, and postoperative cardiac or renal function. Electrode pacing parameters upon operation and 1 month after operation were recorded and analyzed. Results One case suffered from deteriorating cardiac function. No other complications were observed. The electrode pacing threshold value and impedance one month after operation were significantly lower than those upon operation(P<0.05). Conclusion Application of active-fixation pacing leads in extreme elderly patients is effective and safe. The pacing threshold value and impedance of active-fixation leads tend to increase perioperatively, but decrease gradually one month after operation.
引文
[1]Stevenson RT,Lugg D,Gray R,et al.Pacemaker implantation in the extreme elderly[J].Inter Card Electrophysiol,2012,33(1):51-58.
[2]Kusumoto FM,Phillips R,Goldschlager N.Pacing therapy in the elderly[J].Am J Geriatr Cardiol,2002,11(5):305-316.
[3]韩战营,郑绪伟,邱春光,等.8 0岁及以上患者起搏器治疗的特殊性分析[J].中华老年医学杂志,2014,33(7):748-750.
[4]李燕萍,郝应禄,廖德荣,等.530例心房主动电极的临床应用[J].昆明医科大学学报,2017,38(6):130-135.
[5]艾民,颜昌福,贺剑,等.主动固定螺旋电极右心室间隔部起搏参数变化随访研究[J].岭南心血管病杂志,2017,23(1):56-58.
[6]孙志明,张燕.病窦综合征患者起搏器植入中应用主动电极11例临床研究[J].陕西医学杂志,2018,47(4):488-49 0.
[7]Epstein AE,Dimarco JP,Ellenbogen KA,et al.ACC/AHA/HRS 2008 Guidelines for device-based therapy of cardiac rhythm abnormalities:executive summary[J].Heart Rhythm,2008,5(6):934-955.
[8]Lakhan SE,Harle L.Cardiac fibrosis in the elderly,normotensive athlete:case report and review of the literature[J].Diagn Patholo,2008,3:12.
[9]Hsueh CW,Lee WL,Chen YT,et al.The incidence of coronary artery disease in patients with symptomatic bradyarrhythmias[J].Jpn Heart J,2001,42(4):417-423.
[10]McManus DD,Hsu G,Sung SH,et al.Atrial fibrillation and outcomes in heart failure with preserved versus reduced left ventricular ejection fraction[J].Am Heart Assoc,2013,2(1):e005694.
[11]杨军,曹佳宁,陈英,等.不同永久起搏电极植入右室心尖部的损伤电流变化[J].心脏杂志,2016,28(6):683-685.
[12]Redfearn DP,Gula LJ,Krahn AD,et al.Current of injury predicts acute per for mance of catheter-delivered active fixation pacing leads[J].Pacing Clin Elecirophysiol,2007,30(12):1 438-1 444.
[13]Laske TG,Skadsberg ND,Hill AJ,et al.Extitation of the intrinsic conduction system through his and interventricular septal pacing[J].Pacing Clin Elctrophysiol,2006,29(4):397-405.
[14]Saito M,Kaye G,Negishi K,et al.Dyssynchrony,contraction efficiency and regional function with apical and non-apical RVpacing[J].Heart,2015,101(8):600-608.
[15]Yu CM,Fang F,Luo XX,et al.Long-term follow-up results of the pacing to avoid cardiac enlargement(PACE)trial[J].Eur JHeart Fail,2014,16(9):1 016-1 025.
[16]Semelka M,Gera J,Usman S.Sick sinus syndrome:a review[J].American Family Physian,2013,87(10):691-696.
[2]Kusumoto FM,Phillips R,Goldschlager N.Pacing therapy in the elderly[J].Am J Geriatr Cardiol,2002,11(5):305-316.
[3]韩战营,郑绪伟,邱春光,等.8 0岁及以上患者起搏器治疗的特殊性分析[J].中华老年医学杂志,2014,33(7):748-750.
[4]李燕萍,郝应禄,廖德荣,等.530例心房主动电极的临床应用[J].昆明医科大学学报,2017,38(6):130-135.
[5]艾民,颜昌福,贺剑,等.主动固定螺旋电极右心室间隔部起搏参数变化随访研究[J].岭南心血管病杂志,2017,23(1):56-58.
[6]孙志明,张燕.病窦综合征患者起搏器植入中应用主动电极11例临床研究[J].陕西医学杂志,2018,47(4):488-49 0.
[7]Epstein AE,Dimarco JP,Ellenbogen KA,et al.ACC/AHA/HRS 2008 Guidelines for device-based therapy of cardiac rhythm abnormalities:executive summary[J].Heart Rhythm,2008,5(6):934-955.
[8]Lakhan SE,Harle L.Cardiac fibrosis in the elderly,normotensive athlete:case report and review of the literature[J].Diagn Patholo,2008,3:12.
[9]Hsueh CW,Lee WL,Chen YT,et al.The incidence of coronary artery disease in patients with symptomatic bradyarrhythmias[J].Jpn Heart J,2001,42(4):417-423.
[10]McManus DD,Hsu G,Sung SH,et al.Atrial fibrillation and outcomes in heart failure with preserved versus reduced left ventricular ejection fraction[J].Am Heart Assoc,2013,2(1):e005694.
[11]杨军,曹佳宁,陈英,等.不同永久起搏电极植入右室心尖部的损伤电流变化[J].心脏杂志,2016,28(6):683-685.
[12]Redfearn DP,Gula LJ,Krahn AD,et al.Current of injury predicts acute per for mance of catheter-delivered active fixation pacing leads[J].Pacing Clin Elecirophysiol,2007,30(12):1 438-1 444.
[13]Laske TG,Skadsberg ND,Hill AJ,et al.Extitation of the intrinsic conduction system through his and interventricular septal pacing[J].Pacing Clin Elctrophysiol,2006,29(4):397-405.
[14]Saito M,Kaye G,Negishi K,et al.Dyssynchrony,contraction efficiency and regional function with apical and non-apical RVpacing[J].Heart,2015,101(8):600-608.
[15]Yu CM,Fang F,Luo XX,et al.Long-term follow-up results of the pacing to avoid cardiac enlargement(PACE)trial[J].Eur JHeart Fail,2014,16(9):1 016-1 025.
[16]Semelka M,Gera J,Usman S.Sick sinus syndrome:a review[J].American Family Physian,2013,87(10):691-696.