起搏电极导线脱位的临床探讨

报道 6例起搏器电极导线脱位 ,1例为VDD起搏器 ,其余 5例均为DDD起搏器。共 8根电极导线脱位 ,7根为电极导线游动、1根呈微脱位。脱位后 ,2例再次发生晕厥、3例有明显症状 ,脱位电极导线均为双极电极导线。与以往电极导线脱位率相比 ,双极电极导线在临床中应用增多后引起的起搏电极脱位率有所增高 ,约占同期起搏器总数量的 2 %。这一现象应给予充分重视 ,并采取相应措施减少和预防其发生     

起搏电极导线脱位

起搏电极导线脱位是起搏器术后常见的并发症。大多为发生在起搏器术后6周内的早期脱位,心房电极和双室同步起搏的冠状窦电极的脱位率较高。诊断电极脱位最简便、有效的检查是心电图和X线片,对疑诊患者,应进行起搏器程控。典型的电极导线脱位表现为起搏阈值升高和/或电极导线阻抗降低,严重脱位尚可引起感知不良。根据起搏器置入的时间、患者临床表现、脱位的电极导线情况以及起搏器功能障碍的程度不同,处理方法亦不同,而积极预防是最好的防治电极导线脱位的方法。     

起搏电极导线拔除技术的临床应用

起搏电极导线拔除技术的临床应用马坚王方正拔除起搏电极导线是治疗起搏器埋置术后某些严重并发症的有效方法［１，２］。由于电极导线在埋置后１～２个月便被胶原纤维组织包绕，并与血管和心腔内壁粘连，致使电极导线难以拔除［３］。以往临床上曾应用过多种拔除方法，但...     

激素导线电极临床观察

本文观察12例起搏器患者的激素导线电极植入后起搏阈值变化。这种导线电极与传统导线电极比较,具有低能量输出有效起搏,无明显术后阈值升高和峰值现象。作者认为激素导线电极是一种节能、安全的起搏电极。     

心房电极导线脱位到心室致反复心室安全起搏一例

患者女性,72岁,因病窦综合征行起搏器植入术,术后第4天动态心电图检查发现心房感知不良,反复出现心房起搏脉冲后宽大QRS波及相隔110ms起搏脉冲,胸片检查提示心房电极导线脱落至心室内,心房起搏脉冲起搏心室,宽大QRS波落在交叉感知窗内触发反复心室安全起搏。     

CT诊断右心房起搏器导线电极脱位合并右心房穿孔一例

<正>起搏器导线移位、穿孔是较少见的起搏器置入术后并发症,一旦发生可造成严重后果,应尽早诊断。心电图和胸部X线等常用方法有一定局限性,敏感性较低,CT可作为一种补充方法,弥补其不足,防止导线移位、穿孔的漏诊和误诊。1临床资料患者男性,76岁,2007年3月因病态窦房结综合征、阵发性心房颤动而置入心脏起搏器,模式为频率适应性双腔起搏。术后不适症状缓解,定期规律程控。近期多次出现心前     

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。     

心脏起搏器电极脱位原因的初步探讨

目的随访起搏器置入术后患者,观察起搏电极导线脱位的情况,分析和探讨电极导线脱位的原因。方法总结1065例置入起搏器患者的临床资料,24例起搏器电极导线脱位,7例为VVI/VVIR起搏器,其余15例为DDD/DDDR起搏器。结果共24根电极导线脱位,其中15例电极导线明显移位,9例电极导线微脱位,11根为心室电极导线,13根为心房电极导线。脱位电极导线中23根为双极电极导线,1根为单极电极导线。脱位后3例发生晕厥,3例有黑矇症状。结论心房电极导线脱位率高于心室电极导线,大多数电极导线脱位发生于术后1周内。双极电极导线在临床应用增多后引起的起搏电极脱位率高于单极电极导线,老年人合并基础心脏疾病者电极导线脱位的危险性增高。此外,电极导线脱位与术者置入经验可能有关。     

废弃电极导线断裂致起搏电极移位一例

报道 1例废弃电极导线迟发断裂回缩到右心室 ,并盘绕起搏电极导线导致起搏电极移位 ,并对其原因进行了分析阐述。认为在行锁骨下静脉穿刺时应选择合适的穿刺点 ,置入新电极时 ,应在保证安全前提下尽可能设法拔除废弃电极。     

单根电极导线心室起搏双腔感知双反应方式起搏器远期效果分析

目的　探讨单根电极导线心室起搏双腔感知双反应方式起搏器 (VDD起搏器 )的远期临床使用效果。方法　 1993- 0 3～ 2 0 0 2 - 0 5共植入单根电极导线的VDD起搏器 16例 ,其中男性 12例 ,女性 4例 ,年龄 4 9～ 75岁 ,平均年龄 ( 6 4 4± 7 8)岁。均为窦性心律正常伴完全性房室传导阻滞或高度房室传导阻滞者。常规采用穿刺锁骨下静脉方法植入电极导线 ,起搏器植入电极导线插入的同侧。结果　随访时间 112～ 1个月 ,平均 ( 6 8 8±6 3)个月。全部患者植入后 ,心功能提高 ,临床症状消失 ,长期随访生活质量明显改善 ,无心房感知不良者。 1例因冠心病合并心衰于随访 4 2个月死亡外 ,其余均健在 ,无失访者。结论　只要适应证选择合适 ,使用VDD起搏器手术简单易于操作 ,又可减轻病人负担并能取得最佳的治疗效果 ,心内科同道应重视这类起搏器的选用 ,特别是对于经济不发达地区更为重要     

利用射频消融法拔出起搏电极导线的实验研究

探索利用起搏电极导线直接释放射频能量到心肌组织是否可拔出起搏电极 ,多少能量合适。取新鲜猪心脏 ,切成条状心肌组织块 ,放置于盛有 37～ 38℃生理盐水的不锈钢碗中 ,碗底接射频背部电极 ,将单极导线(MedtronicCapsureSP 4 0 2 3)顶端压在心肌组织上 ,释放射频能量 ,方案为 1,2 ,3,4 ,5W ,时间为 3,6 ,9…… 2 1s,双极导线的顶端电极消融方案同单极电极。双极导线 (MedtronicCapsureSP 4 0 92 ,4 5 92 )的环圈电极放电为 8,10 ,12W ,时间为 5 ,10 ,15 ,2 0s消融后测损伤范围。结果 :单极导线放电 1W、12s,损伤范围是 2 .0± 0 .5mm× 1.7± 0 .6mm ,2W、6s,3W、3s其损伤范围分别是 2 .6± 0 .4mm× 2 .2± 0 .3mm ,2 .3± 0 .3mm× 2 .2± 0 .6mm ,4W、5W ,3s可引起明显心肌损伤。双极导线的顶端电极消融损伤范围与单极导线相比无统计学差异 (P >0 .0 5 )。心室双极导线的环圈电极放电 8W、2 0s ,10W、10s ,其损伤范围分别是 6 .3± 0 .6mm× 5 .0± 0 .0mm ,5 .5± 1.3mm× 4 .3± 0 .6mm。心房双极导线的环圈电极消融损伤范围与心室双极导线相比有统计学差异 (P <0 .0 5 )。结论 :利用起搏电极导线直接释放射频能量到心肌组织体外实验是可行的 ,这有可能成为拔除永久起搏导线的一种简单实用方法。     

VVI型起搏器更换时心室电极直接参数的变化及临床意义

研究长期起搏器治疗后起搏阈值、电极阻抗的变化及电极使用的寿命。 32例病人 ,在起搏器置入术及更换术时 ,用起搏器分析仪直接测量心室电极参数。心室电极在体内埋置时间为 10 4 .2 2± 30 .10 (49～ 16 8)个月。置入时起搏阈值为 0 .72± 0 .33(0 .2～ 1.5 )V ,更换脉冲发生器时为 1.85± 0 .75 (1.0～ 3.5 )V ,P <0 .0 0 0 1。更换脉冲发生器时起搏阈值是置入时的 2 .5 7倍 ,增加幅度为 2 0 1.2 %± 16 2 .9% (10 %～ 70 0 % ) ,增加绝对值为 1.13± 0 .71(0 .1～2 .5 )V。置入时电极阻抗为 6 4 2 .83± 185 .39(333～ 980 )Ω ,更换脉冲发生器时为 70 2 .79± 73.0 0 (40 2～ 12 4 0 )Ω ,P >0 .0 5。更换起搏器后 ,对继续使用原心室电极的 2 8例随访 5 4 .91± 5 1.2 1(1～ 16 8)个月。 3例在更换术后 1～ 2 4个月分别出现起搏及感知障碍 ,再次手术时发现导管不全断裂、绝缘包鞘破损及微脱位。结论 :置入性右心室心内膜电极在使用 8年以上 ,大部分的直接参数在正常范围 ,可考虑继续使用 ,但早年生产的电极 ,更换术时参数即使正常 ,亦不排除电极可能短期内发生故障 ,须随访及定期复查。     

Clinical surveillance of a tined, bipolar, silicone-insulated ventricular pacing lead.

AIMS: This study assesses short- and long-term performance of the S80TB ventricular lead manufactured by Sorin Biomedica, Italy. METHODS AND RESULTS: Three hundred and thirty leads were implanted and had complete follow-up with us for a minimum of 60 months or up to failure, removal, and/or patient death (mean 40 months, range: 1 day to 81 months). Thirty-two patients (9.6%) had spontaneous lead-related complications: 7 (2.1%) occurred during the first week; 25 (7.6%) had chronic complications, of which 20 (6.1%) necessitated re-operations; 3 (0.9%) were lead material failures. Of the 110 re-operations (90 pacemaker replacements and 20 operations due to complications), 7 additional cases (6.4%) were complicated by unique connector damage that occurred during disconnection of the lead from the connector block. The Kaplan-Meier estimated 5-year lead survival free of lead material failure and free of any significant lead complication were 97.9 and 87%, respectively. CONCLUSION: The S80TB lead demonstrates an acceptable rate of acute and chronic spontaneous complications and very few lead material failures over 5 years of follow-up. However, there seems to be a relatively high incidence of connector damage during disconnection from the connector block. Extra caution is required during those procedures in patients with this lead.     

Increased Incidence of Noise in the Tendril Pacemaker Lead Detected via Remote Monitoring

BackgroundPrior studies suggest increased rates of noise on the Tendril (St Jude Medical/Abbott, St. Paul, MN, USA) pacemaker lead. We aim to assess the incidence of lead noise in the Tendril and 5076 (Medtronic PLC, Minneapolis, MN, USA) pacemaker leads in our cohort and in the process assess the utility of remote monitoring for identifying lead malfunction.MethodsDeidentified, multi-centre, prospectively collected observational cohort data was obtained to assess the incidence of noise on the Tendril and 5076 pacemaker leads.Results148 Tendril and 737 CapSureFix Novus 5076 (Medtronic, MN, USA) pacemaker leads were remotely monitored. Incidence of noise on the Tendril was 8% and 0.27% on the CapSureFix Novus.ConclusionRates of noise in the Tendril lead are higher than a market competitor. Remote monitoring is useful in detecting this concerning anomaly.     

Electrical abnormalities with St. Jude/Abbott pacing leads: A systematic review and meta-analysis

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Pacemaker lead thrombo-endocarditis in an intravenous drug abuser

We report a 30-year-old male intravenous drug abuser presenting with persistent pacemaker lead thrombosis with superimposed pacemaker lead endocarditis. He underwent urgent surgery, but expired due to refractory sepsis. This case confirms that patients with pacemakers are at risk of developing pacemaker lead thrombosis. In addition, they are at high risk of developing pacemaker lead endocarditis if additional risk factors for endocarditis are present. We believe this case report is unusual on account of pacemaker lead thrombosis as well as endocarditis occurring in a patient with history of intravenous drug abuse. Whether pacemaker patients with multiple leads need to be on long-term antiplatelet or anticoagulation therapy necessitates further studies.     

Near‐fatal Outcome of Late Cardiac Perforation by a Pacemaker Lead in a Young Woman with Transposition of the Great Arteries

We report a case of ventricular perforation by an active‐fixation permanent pacemaker lead in a young woman with congenital heart defect and pacemaker because of atrioventricular block. The rarity of the case is based not only upon the late perforation (as opposed to the more common acute perforations) but also on the near‐fatal outcome. The patient experienced sharp chest pain and 1 week later passed out with cardiac arrest.