单极电极导线错误连接双极起搏模式三例

3例起搏器患者置入单极导线,而起搏器程控为双极起搏模式,结果导致起搏器不起搏,心电监护上无起搏信号,疑起搏故障,重新手术或更换起搏器,造成损失。因此安装起搏器操作顺序和故障处理的规范化十分重要。     

起搏器置入术中单双极起搏与感知测试的电参数差异

25例患者置入埋藏式起搏器,心房和心室导线到位固定后,测试比较单极和双极起搏与感知参数。结果:心房、心室导线单极起搏阈电压、电阻抗较双极起搏高,单极感知的P/QRS波振幅较双极感知低。     

新型主动固定起搏导线的临床应用

目的评估植入新型主动固定起搏导线的可用性和安全性。方法选择本中心植入永久性人工心脏起搏器患者101例,分为新型导线组（n=25）和传统导线组（n=76）,新型导线组患者植入Medtronic3830导线3根,5086MRI导线14根（包括心房、心室导线）,Boston Scientific4471导线15根;传统导线组患者植入心室主动固定导线76根,心房被动固定导线58根,测量植入后各相关起搏参数,手术时间,曝光时间及心室导线过三尖瓣的次数,并常规随访。结果两组导线的阈值[（0．62-4-0．14）V、（0．63-4-017）V]、振幅[（1129±4．28）mV、（12．74±6．08）mV]、阻抗[（76768±132．73）Q、（815．14±182．46）Q]、电流[（077±0．19）mA、（0．85±0．33）mA]、斜率（2．46±1．07、2．844-102）差异均无统计学意义（均P〉005）,两组起搏导线损伤电流[（6,83±1157）mV、（6．61±1187）mV]、植入手术时间[（44．204-4．65）min、（43．42±5．55）min]、曝光时间[（3．24±1．04）min、（3．33±1．05）min]、导线过三尖瓣次数（1．36±0．57、1．34±0．63）差异均无统计学意义（均P〉0．05）。三种新型起搏导线植入时均未发生并发症,4471导线出现1例术后完全脱位。1年时随访两组导线的阈值、振幅、阻抗异均无统计学意义（均P〉0．05o结论新型起搏导线均符合起搏器植入要求,未增加手术时间和曝光时间,植入安全。     

单极和双极起搏模式起搏阻抗的临床观察及相应起搏电路分析

目的分析双极起搏导线双极模式测量起搏阻抗大于单极模式测量起搏阻抗的原因。方法先前研究中双极测量起搏阻抗始终高于单极测量起搏阻抗,推测这种现象源自电子在双极环路和单极环路有着不同的运动途径。通过对比双极模式和单极模式的等效电路图,显见双极阻抗要高于单极阻抗。结果双极测量起搏阻抗与单极测量起搏阻抗的不同主要在导线阳极环及附近组织的阻抗。结论单双极电极起搏阻抗不同的原因源于电子在双极环路与单极环路运动的不同。     

无导线起搏器在特殊人群中植入的研究进展

无导线起搏器(LP)被开发并引入临床,以解决传统经静脉起搏器导线与囊袋相关的并发症。在对既往LP可用临床数据的回顾中,笔者发现其植入并不复杂,但因特殊人群自身情况的复杂性,LP的植入存在一定难度。现就近几年LP相关文献进行回顾,并分析LP在特殊人群中植入的可操作性、成功性、安全性以及有效性,为特殊人群植入LP的临床治疗和研究提供指引,具有重要的临床价值。     

永久起搏器单双极导线工作性能比较

目的:观察单、双极导线于起搏器置入术中及术后起搏阈值、感知、阻抗的变化规律并比较其差异.方法:对2005-07-2008-04间所有置入双极导线可程控极性起搏器的患者共208例(男101例,女107例,平均年龄63岁)随访1年,分别在置入时、术后1周、1个月、3个月、6个月及1年测试单、双极起搏阈值、阻抗以及P/R振幅,比较同一时间不同极性间各项指标的差异以及同一极性不同时间各项指标的变化情况.结果:无论心房还是心室导线,术中双极起搏能量及电压阈值均显著低于单极(P<0.01).术后1周以及长期随访时二者能量阈值无显著性差异,单极起搏电压阈值低于双极(P<0.01).从术后1周开始,心房和心室双极电压及能量阈值均有升高趋势,心室单极电压及能量阈值有升高趋势.心房单极电压及能量阈值自术后1周开始下降,术后12个月仍低于术中水平.无论心房还是心室导线,双极阻抗于术中及术后任何时间均高于单极(P<0.01),双极P/R振幅于术中及术后任何时间均高于单极(P<0.01).结论:无论心房还是心室导线,术中以及术后起搏压阈值、阻抗以及P/R振幅在单、双极状态下均明显不同,而起搏能量阈值在术中单极高于双极,术后二者无差别.     

铱分型镀覆和激素释放电极导线起搏参数的动态变化

为探讨激素释放电极导线(steroid eluting lead,SEL)和铱分型镀覆电极导线(fractally iridium coated lead,FICL)的起搏阈值和阻抗的变化,本研究回顾分析了2种导线术中、术后1和3个月的起搏阈值和阻抗的变化情况,并进行了比较。2001年1月～2003年12月置入的各种起搏器495台及配套的各类心房、心室起搏导线717根,其中509根为SEL,另208根为FICL。结果:FICL组术中起搏阈值显著低于SEL组(0.40±0.24V vs0.46±0.27V,P<0.05),术后1和3个月FICL组也低于SEL组,但无显著意义。FICL组术中阻抗显著高于SEL组(843±382Ωvs524±210Ω,P<0.01)。术后1和3个月也高于SEL(分别为714±263Ωvs520±241Ω;694±176Ωvs515±227Ω,allP<0.05)。结论:SEL和FICL均为低能量起搏电极导线,并可大幅度降低起搏能量消耗。FICL的感知和起搏功能可长时间保持稳定,并具有独特的感知优势。     

Micra无导线起搏器和传统起搏器的近期临床疗效比较

目的 比较Micra无导线起搏器和传统单腔起搏器的临床应用效果.方法 回顾性纳入因缓慢心律失常住院并植入Micra无导线起搏器的患者为Micra无导线组,以及同时期植入传统单腔起搏器(植入St.Jude 5056型或Metronic Sigma型)的患者为传统组.观察两组手术时间,X线曝光时间,比较两组患者的起搏器费用...     

国人右房、右室导线实际使用长度的单中心统计分析

目的测量国人植入起搏器时右房、右室导线的实际使用长度,为得出适合国人的起搏导线长度提供依据。方法连续入选117例植入起搏器患者,记录其性别、年龄、身高、起搏器类型、导线植入侧(左/右)、静脉植入路径(锁骨下静脉/头静脉)、电极放置的位置(心尖部/流出道)等参数。术中测量静脉入口结扎部位到脉冲发生器连接口处的导线长度,将电极导线总长度减去上述长度得出电极导线实际使用长度,术后通过胸部正位片测量导线进入上腔静脉后垂直下行的反向延长线同左、右锁骨中点连接线的交界点与左/右锁骨中点间距离的差值,得出对侧植入时所需导线的长度。结果左锁骨下路径植入时右房导线实际使用长度为(30.0±2.3)cm;右室导线实际使用长度为(39.1±3.0)cm。右锁骨下路径植入时右房导线实际使用长度为(26.5±2.8)cm;右室导线实际使用长度为(33.5±2.8)cm。Spearman′s单因素相关分析发现,右房导线实际使用长度主要与身高(r=0.475,P0.001)相关,右室导线实际使用长度主要与身高(r=0.533,P0.001)相关;结论相对于常规使用的心房心室导线长度(心房53cm/心室58cm),国人选择心房导线40cm/心室导线50cm应该是可行和更合理的。     

永久心脏起搏器导线单极和双极性能比较

人工心脏起搏器(artificial cardiac pacemaker)是以发出脉冲电流带动心脏起搏的一种装置.自1958年10月Ake Senning和Rune Elmquist在瑞典为因三度房室阻滞反复发生晕厥的43岁的Arne Larsson置人世界第一台心脏起搏器后,无数心脏病患者,尤其是缓慢型心律失常患者,已经受益.到目前,起搏器的适应证不断被拓宽,由原来的针对缓慢性心律失常扩展到对室性心动过速、肥厚型梗阻性心肌病、扩张型心肌病、药物难于控制的充血性心力衰竭及对心房颤动的治疗等.     

Comparison of unipolar versus bipolar ablation and single electrode control versus simultaneous multielectrode temperature control

Background Creation of linear lesions using multielectrode catheters may be effective at treating cardiac arrhythmias. Objective We compared unipolar versus bipolar ablation, evaluated the effects of varying effective electrode areas, and compared single electrode versus multielectrode temperature control during multielectrode radiofrequency ablation. Methods Intramural radiofrequency ablation was performed on five greyhounds at thoracotomy, from an epicardial approach using a 0.8 mm diameter bipolar electrode needle. Fifteen left ventricular ablations were performed per animal. Intramural ablation was performed to maintain a constant electrode–tissue interface. The distal and proximal electrodes measured 1.5 and 1.0 mm in length respectively with an interelectrode distance of 4 mm. Radiofrequency energy was applied to both electrodes simultaneously for 60 s using a target temperature of 80°C. During bipolar ablation, the temperature was regulated from either the distal (BPA1.5) or proximal (BPA1.0) electrode only. During unipolar ablation (UPA), the temperature at both electrodes were simultaneously controlled. Lesions were assessed histologically. Results During UPA, consistent target temperatures were achieved at both electrodes. In comparison to UPA, the temperature at both electrodes were significantly decreased during BPA1.0. During BPA1.5 a significant (p < 0.001) temperature increase (94.7 ± 2.1°C) was observed at the 1.0 mm electrode. BPA1.0 resulted in reduced (p = 0.008) lesion width at the 1.5 mm electrode and no change in lesion depth (p = 0.064) at both electrodes compared to UPA. Conversely, lesion dimensions increase significantly at both electrodes during BPA1.5. Conclusion Unipolar multielectrode ablation with simultaneous temperature control at both electrodes is more predictable and hence likely to be safer than bipolar ablation.     

静脉盐酸地尔硫卓对起搏阈值及心内电信号振幅的影响

目的探讨静脉盐酸地尔硫卓对起搏阈值及心内电信号振幅的影响。方法植入心脏起搏器术后1～3天的患者133例,静脉注射盐酸地尔硫卓注射液10 mg,间隔10 min后重复给药10 mg,采取体外程控仪,测定用药前及用药后30,60,120,240 min时的心房、心室起搏阈值及P波、R波振幅。结果用药前及用药后不同时段的心房、心室起搏阈值及P波、R波振幅均无明显变化(P>0.05)。结论静脉注射盐酸地尔硫卓对急性期起搏阈值及心内电信号振幅均无影响。     

Latest generation of unipolar and bipolar steroid eluting leads: long-term comparison of electrical performance in atrium and ventricles.

One hundred and seventy-three patients, mean age 74 years permanently paced with 123 atrial (53 unipolar, 70 bipolar) and 143 ventricular (73 unipolar, 70 bipolar) pacing leads were included in this study. The pacing leads were recent generation low surface area steroid eluting leads from one manufacturer: leads with silicone and polyurethane insulation were studied, and they were combined with generations of one pacemaker family from the same manufacturer permitting identical measurements to be made over a follow-up of 2 years. Pacing threshold was measured using pulse duration at a fixed voltage of 1.5 V: peak to peak P and R wave amplitude and pacing impedance at 2.5 V and 0.5 ms were all measured using the manufacturer's standard programmer. Although many significant differences, in the parameters measures, existed between atrium and ventricle and unipolar and bipolar configurations, none was felt to be of clinical significance. These data permit the physician to choose the lead type with regard to sensing performance and long-term lead integrity.     

V1与V3R～V6R导联QRS波群相关性分析

目的探讨右胸导联正常QRS波群的内在规律。方法观察220例健康大学生常规12导联和V3R-V6R导联心电图，分析V1QRS波群呈不同形态时V3R-V6R导联QRS形态和q波时间、电压及q／R比值。结果V3R-V6R与V1QRS形态相似率逐导联降低；V3R-V6Rq及Qs波出现率逐导联增高（1．82％、6．82％、23．64％、47．27％）；V1呈Rs时V3R、V4R无q或QS波，V1呈QS时V3R、V4R均呈QS型；V3R、V4R或V5R出现q或QS波，则其右侧导联也出现q或QS波（即不会单个导联出现q或QS波）；V3R-V6Rq波时间〈0．04s，q／R比值可〉1／4。结论正常人右胸导联可出现q或QS波，孤立导联的q或QS波有临床意义。     

固定螺旋主动固定导线植入早期及后期参数变化与安全性评价

目的 评价固定螺旋主动固定导线（Fineline Ⅱ EZ,美国波科公司）植入术中及术后3个月参数变化情况,评价其安全性.方法 2012年1月至2013年9月在青岛大学附属医院156例缓慢性心律失常患者行单腔或双腔起搏治疗,心室起搏导线均选用固定螺旋主动固定导线,经左或右侧锁骨下静脉置于右心室流出道间隔部,分别于导线旋入心肌即刻、旋入后5 min、术后即刻、术后3个月测试起搏参数：起搏阈值、导线阻抗和R波幅度,并观察术后有无导线脱位、导线穿孔、与经静脉有关的血栓形成及囊袋感染等严重并发症发生.结果 导线旋入即刻起搏阈值较高,5 min后明显下降[（0.76±0.22）V对（0.39±0.13）V,P＜0.001];术后即刻阈值较旋入5 min后进一步下降[（0.35±0.10）V对（0.39±0.13）V,P＜0.001].R波幅度在导线旋入后5 min测试较术后即刻降低[（12.70±4.94）mV对（8.94±4.07） mV,P＜0.001].术后仅1例患者出现导线脱位,无导线穿孔、囊袋感染等并发症发生.结论 固定螺旋主动固定导线旋入心肌5 min后起搏阈值明显降低,故可常规于旋入5min后进行测试,确定是否需要调整导线位置.固定螺旋主动固定导线在应用过程中是安全有效的.     

Radionuclide ejection fraction and regional wall motion during atrial pacing in stable angina pectoris: Comparison with metabolic and hemodynamic parameters

To evaluate the effects of atrial pacing on radionuclide (RNA) ejection fraction (EF) and regional wall motion (RWM), transmyocardial lactate gradients and hemodynamics in stable coronary artery disease (CAD), 12 CAD patients underwent incremental atrial pacing during cardiac catheterization. EF declined from 0.60 ± 0.07 during control state to 0.51 ± 0.11 (p < 0.001) during submaximal pacing (Sub Max P) with 10 of 12 having decreased EF, six developing new RWM abnormalities, and five experiencing mild chest pain. During maximal pacing (Max P), EF declined further to 0.47 ± 0.10 (p < 0.001), with all patients having decreased EF and experiencing moderate to severe chest pain, and nine developing new RWM abnormalities. Percentage lactate extraction (Ex) decreased from +28.3 ± 9.4% to +17.4 ± 11.9% during Sub Max P (p < 0.01), with only one patient producing lactate. During Max P, percentage lactate Ex decreased to ?0.1 ± 15.3% (p < 0.001) with eight patients producing lactate. Significant increases in pulmonary capillary wedge pressure and systemic vascular resistance occurred during Max P, and in mean pulmonary artery pressure and mean systemic arterial pressure during both Sub Max and Max P. Significant decreases in stroke volume index and stroke work index occurred during both pacing levels and cardiac index did not change with pacing. This study demonstrates that RNA may be used to establish decreases in EF and RWM which occur in response to incremental atrial pacing in patients with stable CAD, and that these changes are more consistent and appear earlier than the metabolic consequences of myocardial ischemia induced by pacing stress.     

Current of injury is an indicator of lead depth and performance during left bundle branch pacing lead implantation

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