单根电极心室起搏双腔感知双重反应型起搏器心房感知功能的测试观察

目的：观察单根电极心室起搏双腔感知双重反应型起搏器（ＶＤＤ）心房电极感知功能的稳定性。方法：测试了１４例安装单根电极ＶＤＤ的患者在不同体位、扩胸运动及日常活动时的心房漂浮电极的最低感知阈值。并将术中测得的Ｐ波与术后测得的心房最低感知阈值做相关及线性回归分析。结果：１４例中有１２例患者不同体位的心房感知阈值不一致。其中９例在坐、立位时感知阈值最低，将心房感知阈值调至较最低感知阈值低两档的位置后做Ｈｏｌｔｅｒ检查，全部患者心房感知、房室顺序起搏功能良好。扩胸运动中无一例患者出现过度感知。术中所测Ｐ波振幅与术后测得的最低心房感知阈值相关性良好（ｒ＝０．６９，Ｐ＜０．０５）。结论：单根电极ＶＤＤ可替代双电极导管的双腔起搏双腔感知双重反应型起搏器（ＤＤＤ），用于窦房结功能正常的高度房室传导阻滞患者的起搏治疗。     

单根电极VDD起搏器的初步应用（附七例报告）

自１９９４年１～１０月共为７例（完全性房室传导阻滞６例、高度房室传导阻滞１例）病人应用了单电极ＶＤＤ起搏器。术后随诊３～１２（平均６．５±２．５）个月，动态心电图监测全部达到心房同步起搏的目的，其中１例有个别间断性Ｐ波感知差而自动转为ＶＶＩ起搏，但总的Ｐ波感知率在９８％以上。如植入病例经严格选择（窦房功能正常的房室传导阻滞），单电极ＶＤＤ起搏可代替双腔ＤＤＤ起搏。     

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

植入单根电极导线的VDD起搏器16例,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112～1个月,平均(68.8±6.3)个月。全部患者植入后,心     

单根导线VDD起搏器的临床应用

单根导线VDD起搏系统保持了心脏的房室顺序收缩和频率适应的特点，是一种生理性起搏系统，且植入技术简便，价格较为便宜，适用于窦房结功能正常的房室阻滞的患者，但对于远期窦房结功能及心房感知情况的担心在一定程度上限制了其应用。国内加世纪90年代初、中期开始在临床上应用，早期患者已陆续进入起搏器更换阶段。本文就我院植入单根导线VDD起搏器患者的随访，作一简要分析。     

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...     

DDD型起搏器呈VDD起搏时心房起搏信号的分析——附1例体会

全自动型起搏器(DDD),具有根据病人自身心率变化而自动转换不同起搏方式的功能。我们在为1倒病人安装DDD术中,行心房参数测试时心房起搏信号不能规律出现．经分析明确为起搏器呈心房同步心室抑制型(VDD)起搏所致,现将情况简介如下,供同行参考。     

起搏器与电极导线连接处接触不良一例

患者女性，61岁。因病窦综合征安置DDD起搏器。起搏器与电极导线连接后末观测到起搏心电图即结束手术。术后2h发现起搏器呈VVI起搏方式，不能感知、起搏心房。手术探查，重新连接起搏器与心房电极，起搏器呈DDD起搏方式。提示：肉眼观测电极尾端插入到位且拧紧起搏器接口螺丝，仍应结合起搏心电图判断起搏器与电极导线是否连接良好。     

起搏器更换时原心房心室电极直接参数的分析及意义

目的:分析更换起搏脉冲发生器时电极导线的各项直接参数并评估其意义.方法:76例患者,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/心房电极参数.其中,VVI起搏器34例,VDD起搏器4例,AAI起搏器4例,DDD起搏器34例,心房电极38例,心室电极72例.至更换脉冲发生器时心室电极在体内埋植时间为97±16(63～158)个月,心房电极在体内埋置时间为88±12(63～125)个月.结果:首次埋置时心房、心室电极起搏阈值分别为0.82±0.21 V、0.58±0.27 V,更换脉冲发生器时心房、心室电极起搏阈为1.37±0.64 V、1.06±0.54 V(P＜0.01),分别是置入时的1.68倍和1.83倍.置入时心房电极阻抗为693.6±125.9(368.4～1022.1)Ω,更换脉冲发生器时为694.4±281.8 Ω(P＞0.05),置入时心室电极阻抗为611.8±194.2 Ω(P＞0.05),更换脉冲发生器时为665.9±227.4(437～1346)Ω(P＞0.05).更换前后心房电极P波与心室电极R波振幅无统计学差异.更换起搏器时,5例心室电极,4例心房电极因起搏阈值大于2.5 V或阻抗小于300 Ω而重新植入电极导线.结论:植入性右心室右心房电极使用7年以上时,大部分的直接参数在正常范围,可以继续使用.     

起搏器与电极导线不匹配一例

患者女性,61岁,因Ⅲ度房室传导阻滞植入DDD起搏器。心房、心室电极导线参数测试满意后与起搏器连接,心电监护示:心房率78次/分,心室率38次/分,未见心室起搏心律。术中探查,用程控仪测心室电极阻抗9999Ω,心房电极阻抗正常;然后将心房、心室电极导线互换分别插入起搏器心室、心房电极插入孔,测试示:心室电极导线阻抗9999Ω,心房电极导线阻抗正常。提示:心室电极导线与起搏器不匹配,更换心室电极导线,起搏器呈VDD起搏模式。     

VDD起搏系统的临床应用和长期稳定性观察

对25例窦房结功能正常的完全房室阻滞患者采用锁骨下静脉穿刺法,置入了单导线VDD起搏系统,并进行术后长期随访,通过动态心电图进行房室同步的监测。结果:25例均成功置入VDD起搏系统。术中测右房A波感知振幅为2.43±0.75mV。随访期为6个月至4年,术后1周和1,3,6,12个月的P波振幅均小于术中,有显著性差异,P<0.01。术后1周及3,6,12个月动态心电图显示心房同步百分率分别为99.97%±0.01%,99.98%±0.01%,99.98%±0.02%,99.99%±0.01%,各数值间比较无显著性差异。随访中未发生心房感知不良、过感知或起搏器介导性心动过速等并发症。结论:单导线VDD双腔起搏系统具有安装简单、房室同步功能稳定及生理性起搏的特点,适合窦房结功能正常的房室阻滞患者。     

VDD pacemaker replacement is safe and reliable independently of the previously implanted lead: A prospective and controlled study

Theoretically, replacement of a VDD device requires using a similar pacemaker to provide the best match between the filtering characteristics of the pacemaker and the atrial dipole of the lead. This study evaluated the performance of newly implanted Vitatron VDD pacemakers connected to dedicated leads and compared the results with those of the same Vitatron pacemakers used as replacement but connected to a variety of nondedicated leads. Methods: 23 consecutive patients (15 M, 8 F, 78 ± 6 years) in Group 1 underwent pacemaker replacement with a VDD(R) Saphir 3 (Vitatron BV, Arnhem, The Netherlands) device designed for an 8.6 mm atrial dipole. Atrial dipoles of the previously implanted leads ranged from 5 to 30 mm. Another 22 consecutive patients (14 M, 8 F, 80 ± 7 years) in Group 2 received a Saphir 3 pacemaker with the related dedicated lead. Results: P-wave amplitude measured by the same Pacing Sensing Analyzer (PSA) at the first implantation was 1.7 ± 0.8 vs. 1.7 ± 0.5 mV (P = NS) in groups 1 and 2 respectively. P-wave amplitudes measured at 1 month follow-up after replacement in Group 1 and at 1 month follow-up after implantation in Group 2 were 0.69 ± 0.5 vs. 0.85 ± 0.3 mV (P = NS) respectively. The percentage of atrial sensing at the same follow-up was 97 ± 3 vs. 95 ± 5% (P = NS) in groups 1 and 2 respectively. Conclusions: Replacement of VDD pacemakers with the Saphir 3 model designed for a short dipole is safe and reliable when used in combination with previously implanted nondedicated leads.     

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     

起博电极导线脱位的临床探讨

报道6例起博器电极导线脱位，1例为VDD起博器，其余5例均为DDD起博器。共8根电极导线脱位，7根为电极导游动、1根呈微脱位。脱位后，2例再次发生晕厥、3例有明显症状，脱位电极导级均为双极电极导线。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博电极脱位率有所增高，约占同期起博器总数量的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。     

老年人单导管DDD、VDD起搏系统的临床应用

目的：观察老年人单导管双腔起搏器（DDD）和心房感知型起搏器（VDD）起搏系统的临床应用。方法：18例老年人采用锁骨下静脉穿刺法植入单导管DDD和VDD起搏器,并在植入后1周,3－6月分别做动态心电图（Holter）观察,随访时间6月－4年。结果：18例患者均成功植入单导管DDD和VDD起搏系统。Holter检查显示：VDD和DDD起搏器的工作模式大多为VAT,房室同步起搏率达95％以上。结论：单导管DDD和VDD起搏系统安装简单,无心房电极脱位等优点,尤其适用于老年患者。     

Right atrial sensing for VDD pacing through a persistent left superior vena cava

This report describes a pacing lead insertion through a persistent left superior vena cava in the VDD pacing mode, with a large retrograde lead course allowing the optimal positioning of the sensing electrodes in the right atrium.     

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.     

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.