心室无导线起搏器植入部位的初步探讨
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摘要
目的探讨高位室间隔植入无导线起搏器的可行性和安全性。方法选取本院参与国内首次无导线起搏器临床研究的患者,比较高位室间隔植入无导线起搏器(A组)与低位室间隔植入者(B组)的有关参数。结果共入选15例患者,均顺利植入Micra起搏器。A组8例,B组7例,A组及B组在植入时的起搏阈值[0.38(0.22)mV vs 0.63(1.00)mV]、R波感知[(10.9±4.7) mV vs (7.3±3.0) mV]、电极阻抗[(906.3±162.4)Ωvs (750.0±173.4)Ω]、T波同步导联数[(7.2±2.7) vs (7.1±2.5)]差异均无显著性(P>0.05)。起搏QRS时限A组有缩短的趋势(140.0 ms vs 179.0 ms,P>0.05),A组起搏QTc短于B组(440.0 ms vs 520.0 ms,P<0.05),A组在手术中的透视时间短于B组[12.86(5.36) min vs 18.46(4.41) min,P<0.05]。两组在出院前、随访1个月时的阈值、感知及阻抗差异均无显著性(P>0.05)。结论高位室间隔植入Micra无导线起搏器安全、可行,起搏的心室除极与复极顺序可能优于低位间隔起搏。
Objective To investigate the feasibility and safety of high ventricular septal implantation of leadless pacemaker(Micra). Methods The patients who participated in the first clinical study of Micra in our hospital were selected and the parameters of Micra implanted in high ventricular septum(group A) and low ventricular septum(group B) were compared. Results A total of 15 patients were enrolled, and Micra pacemaker was successfully implanted. There were no significant differences in pacing threshold [0.38(0.22) mV vs 0.63(1.00) mV], R-wave perception [(10.9±4.7) mV vs(7.3±3.0) mV], electrode impedance [(906.3±162.4) Ω vs(750.0±173.4) Ω], T-wave synchronous leads [(7.2±2.7) vs(7.1±2.5)] between group A(n=8) and group B(n=7) at implantation(P>0.05). The pacing QRS time in group A was shorter than that in group B(440.0 msvs 520.0 ms, P<0.05), and the fluoroscopy time in group A was shorter than that in group B [12.86(5.36) min vs 18.46(4.41) min,P<0.05]. There was no significant difference in threshold,R perception and impedance between the two groups before discharge and 1 month after follow-up(P>0.05). Conclusion Micra lead-free pacemaker implantation into high ventricular septum is safe and feasible, and the sequence of ventricular depolarization and repolarization may be better than that of low ventricular septum pacing.
Objective To investigate the feasibility and safety of high ventricular septal implantation of leadless pacemaker(Micra). Methods The patients who participated in the first clinical study of Micra in our hospital were selected and the parameters of Micra implanted in high ventricular septum(group A) and low ventricular septum(group B) were compared. Results A total of 15 patients were enrolled, and Micra pacemaker was successfully implanted. There were no significant differences in pacing threshold [0.38(0.22) mV vs 0.63(1.00) mV], R-wave perception [(10.9±4.7) mV vs(7.3±3.0) mV], electrode impedance [(906.3±162.4) Ω vs(750.0±173.4) Ω], T-wave synchronous leads [(7.2±2.7) vs(7.1±2.5)] between group A(n=8) and group B(n=7) at implantation(P>0.05). The pacing QRS time in group A was shorter than that in group B(440.0 msvs 520.0 ms, P<0.05), and the fluoroscopy time in group A was shorter than that in group B [12.86(5.36) min vs 18.46(4.41) min,P<0.05]. There was no significant difference in threshold,R perception and impedance between the two groups before discharge and 1 month after follow-up(P>0.05). Conclusion Micra lead-free pacemaker implantation into high ventricular septum is safe and feasible, and the sequence of ventricular depolarization and repolarization may be better than that of low ventricular septum pacing.
引文
1 李巧元,郭成军.无导线起搏器与无导线微型起搏器应用的研究进展[J].中国医药,2016,5(11):763
2 Reddy VY,Knops RE,Sperzel J,et al.Permanent leadless cardiac pacing:results of the LEADLESS trial[J].Circulation,2014,129:1 466
3 Epstein AE,Dimarco JP,Ellenbogen KA,et al.ACC/AHA/HRS 2008 Guidelines for Device-based Therapy of Cardiac Rhythm Abnormalities:A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices)[J].Heart Rhythm,2008,5(6),e1
4 Roberts PR,Clementy N,Al Samadi F,et al.A leadless pacemaker in the real-world setting:the Micra Transcatheter Pacing System Post-Approval Registry[J].Heart Rhythm,2017,14:1 375
5 Duray GZ,Ritter P,El-Chami M,et al.Long-term performance of a transcatheter pacing system:12-month results fromthe Micra Transcatheter Pacing Study[J].Heart Rhythm,2017,14:702
6 Amin AK,Billakanty SR,Chopra N,et al.Premature ventricular contraction induced polymorphic ventricular tachycardiaafter leadless pacemaker implantation:a unique adverse effect of leadless pacing[J].Heart Rhythm Case Rep,2018,4:180
7 Boveda S,Lenarczyk R,Haugaa KH,et al.Use of leadless pacemakers in Europe:results of the European Heart Rhythm Association survey[J].Europace,2018,20:555
8 牛云茜,谭冠昶,柯于梵,等.23例Micra TPS微型无导线起搏器初步临床应用经验[J].中国心脏起搏与心电生理杂志,2018,32(5):431
9 张英川,李海宴,陈慧敏,等.右室流入道间隔部起搏的临床可行性[J].中华心律失常学杂志,2000,2:117
2 Reddy VY,Knops RE,Sperzel J,et al.Permanent leadless cardiac pacing:results of the LEADLESS trial[J].Circulation,2014,129:1 466
3 Epstein AE,Dimarco JP,Ellenbogen KA,et al.ACC/AHA/HRS 2008 Guidelines for Device-based Therapy of Cardiac Rhythm Abnormalities:A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices)[J].Heart Rhythm,2008,5(6),e1
4 Roberts PR,Clementy N,Al Samadi F,et al.A leadless pacemaker in the real-world setting:the Micra Transcatheter Pacing System Post-Approval Registry[J].Heart Rhythm,2017,14:1 375
5 Duray GZ,Ritter P,El-Chami M,et al.Long-term performance of a transcatheter pacing system:12-month results fromthe Micra Transcatheter Pacing Study[J].Heart Rhythm,2017,14:702
6 Amin AK,Billakanty SR,Chopra N,et al.Premature ventricular contraction induced polymorphic ventricular tachycardiaafter leadless pacemaker implantation:a unique adverse effect of leadless pacing[J].Heart Rhythm Case Rep,2018,4:180
7 Boveda S,Lenarczyk R,Haugaa KH,et al.Use of leadless pacemakers in Europe:results of the European Heart Rhythm Association survey[J].Europace,2018,20:555
8 牛云茜,谭冠昶,柯于梵,等.23例Micra TPS微型无导线起搏器初步临床应用经验[J].中国心脏起搏与心电生理杂志,2018,32(5):431
9 张英川,李海宴,陈慧敏,等.右室流入道间隔部起搏的临床可行性[J].中华心律失常学杂志,2000,2:117