三维标测系统指导行希氏束区永久起搏器植入术的可行性探讨
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摘要
目的:探讨三维标测系统(EnSite)指导行希氏束区永久起搏器植入术的可行性。方法:对66例有常规心脏起搏适应证的患者,在EnSite指导下行希氏束区永久起搏器植入术,并进行门诊随访3个月。观察患者术中及术后体表心电图QRS波群时限、心室起搏阈值、R波振幅及阻抗情况。结果:66例患者均植入永久起搏器,其中44例(66.7%)成功希氏束区起搏。术后即刻体表心电图QRS波群时限(119.41±5.99) ms,术后3个月体表心电图QRS波群时限(120.35±6.38) ms。术中(急性期)心室起搏阈值(0.89±0.16)V,R波振幅(8.23±3.06) mV,阻抗(702.73±103.12)Ω;术后3个月(慢性期)心室起搏阈值(0.95±0.11) V,R波振幅(8.13±2.26) mV,阻抗(679.77±103.12)Ω,术中各参数与术后3个月相比,差异均无统计学意义(P均>0.05)。结论:EnSite指导行希氏束区永久起搏器植入术可行、有效。
Objectives:To explore the feasibility of His-bundle region pacemaker implantation guided by EnSite system.Methods: Present study included 66 patients underwent His-bundle region pacemaker implantation guided by EnSite system. All patients were followed up for 3 months post pacemaker implantation. The QRS width, the pacing threshold, the sensed potential and the impedance were observed immediately after the operation and at 3 months post operation.Results:His-bundle region pacemaker implantation was successfully performed in 44 patients. The overall success rate was 66.7%(44/66). The QRS width was(119.41±5.99) ms after pacemaker implantation. The pacing threshold, the sensed potential and the impedance were(0.89±0.16) V,(8.23±3.06) mV, and(702.73±103.12) Ω respectively immediately after implantation. The pacing threshold, the sensed potential and the impedance were(0.95±0.11) V,(8.13±2.26) mV and(679.77±103.12) Ωrespectively at 3 months post implantation, the values obtained at the two periods were similar(all P>0.05).Conclusions:His-bundle region pacemaker implantation guided by EnSite system is feasible and effective.
Objectives:To explore the feasibility of His-bundle region pacemaker implantation guided by EnSite system.Methods: Present study included 66 patients underwent His-bundle region pacemaker implantation guided by EnSite system. All patients were followed up for 3 months post pacemaker implantation. The QRS width, the pacing threshold, the sensed potential and the impedance were observed immediately after the operation and at 3 months post operation.Results:His-bundle region pacemaker implantation was successfully performed in 44 patients. The overall success rate was 66.7%(44/66). The QRS width was(119.41±5.99) ms after pacemaker implantation. The pacing threshold, the sensed potential and the impedance were(0.89±0.16) V,(8.23±3.06) mV, and(702.73±103.12) Ω respectively immediately after implantation. The pacing threshold, the sensed potential and the impedance were(0.95±0.11) V,(8.13±2.26) mV and(679.77±103.12) Ωrespectively at 3 months post implantation, the values obtained at the two periods were similar(all P>0.05).Conclusions:His-bundle region pacemaker implantation guided by EnSite system is feasible and effective.
引文
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[10]刘小青,周旭,杨刚,等.EnSite NavX引导无X线透视射频导管消融治疗阵发性室上性心动过速[J].中华心律失常学杂志,2011,15(4):275-278.DOI:10.3760/cma.j.issn.1007-6638.2011.04.009.
[11]丁立刚,华伟,刘志敏,等.三维电解剖标测系统指导孕妇起搏器植入一例[J].中国循环杂志,2015,30(12):1224.DOI:10.3969/j.issn.1000-3614.2015.12.025.
[12]张荣君,邵明凤,张守文,等.三维标测系统指导微射线下行双腔永久起搏器植入术的可行性探讨[J].中国循环杂志,2018,33(2):178-180.DOI:10.3969/j.issn.1000-3614.2018.02.016.
[13]Perlsinakis K,Damilakis J,Theocharopoulos N,et al.Accurate assessment of patient effective radiation dose and associated detriment risk from radiofrequency catheter ablation procedures[J].Circulation,2001,104(1):58-62.DOI:10.1161/hc2601.091710.
[14]王娜,梁延春,于海波,等.希氏束起搏在需要高比例心室起搏的窄QRS波群患者中的应用探讨[J].中国心脏与起搏电生理杂志,2017,31(5):401-407.DOI:10.13333/j.cnki.cjcpe.2017.05.005.
[2]Andersen HR,Nielsen JC,Thomsen PE,et al.Long-term follow-up of patients from a randomised trial of atrial versus ventricular pacing for sick-sinus syndrome[J].Lancet,1997,350(9086):1210-1216.DOI:10.1016/S0140-6736(97)03425-9.
[3]吴高俊,苏蓝,方丹红,等.永久希氏束起搏的临床应用[J].中华心律失常学杂志,2012,16(4):302-306.DOI:10.3760/cma.j.issn.1007-6638.2012.04.005.
[4]Catanzariti D,Maines M,Cemin C,et a1.Permanent direct his bundle pacing does not induce ventricular dyssynchrony unlike conventional right ventricular apical pacing,An intra patient acute comparison study[J].J Interv Card Electrophysiol,2006,16(2):81-92.DOI:10.1007/s10840-006-9033-5.
[5]Lustgarten D L,Calame S,Crespo M,etal.Electrical resynchronization induced by direct His-bundle pacing[J].Heart Rhythm,2010,7(1):15-21.DOI:10.1016/j.hrthm.2009.09.066.
[6]Manovel A,Barba-Pichardo R,Tobaruela A.Electrical and mechanical cardiac resynchronisation by novel direct his-bundle pacing in a heart failure patient[J].Heart Lung Circ,2011.20(12):769-772.DOI:10.1016/j.hlc.2011.05.617.
[7]Deshmukh P,Casavant D,Romannyshyn M,et al.Permanent,direct his-bundle pacing-a novel approach to cardiac pacing in patients with normal his-purkinje activation[J].Circulation,2000,101(8):869-877.DOI:10.1161/01.CIR.101.8.869.
[8]Cantu F,de Filippo P,CardanoP,et al.Validation of criteria for selective his bundle and para-hisian permanent pacing[J].Pacing Clin Electrophysiol,2006,29(12):1326-1333.DOI:10.1111/j.1540-8159.2006.00543.x.
[9]张荣君,张守文,邵明凤,等.零X线下阵发性室上性心动过速不同导管消融比较[J].实用心电学杂志,2018,27(1):23-28.DOI:10.13308/j.issn.2095-9354.2018.01.005.
[10]刘小青,周旭,杨刚,等.EnSite NavX引导无X线透视射频导管消融治疗阵发性室上性心动过速[J].中华心律失常学杂志,2011,15(4):275-278.DOI:10.3760/cma.j.issn.1007-6638.2011.04.009.
[11]丁立刚,华伟,刘志敏,等.三维电解剖标测系统指导孕妇起搏器植入一例[J].中国循环杂志,2015,30(12):1224.DOI:10.3969/j.issn.1000-3614.2015.12.025.
[12]张荣君,邵明凤,张守文,等.三维标测系统指导微射线下行双腔永久起搏器植入术的可行性探讨[J].中国循环杂志,2018,33(2):178-180.DOI:10.3969/j.issn.1000-3614.2018.02.016.
[13]Perlsinakis K,Damilakis J,Theocharopoulos N,et al.Accurate assessment of patient effective radiation dose and associated detriment risk from radiofrequency catheter ablation procedures[J].Circulation,2001,104(1):58-62.DOI:10.1161/hc2601.091710.
[14]王娜,梁延春,于海波,等.希氏束起搏在需要高比例心室起搏的窄QRS波群患者中的应用探讨[J].中国心脏与起搏电生理杂志,2017,31(5):401-407.DOI:10.13333/j.cnki.cjcpe.2017.05.005.