植入性心脏起搏器更换时心室电极直接参数的变化

分析了本院 90年代以来更换起搏脉冲发生器时心室电极参数的直接测量结果。在 2 6例病人中 ,男 15例、女 11例 ,年龄 6 3 .9± 13.6 ( 19～ 90 )岁。Ⅲ度房室阻滞 14例、病窦综合征 12例。在更换手术中 ,应用起搏分析仪直接测量原心室起搏电极参数。结果 :至测量时原心室起搏电极在体内埋置时间为 114.2± 2 7.4( 5 8～ 179)个月。首次埋置时的起搏阈值为 0 .5 9± 0 .2 7V ,更换脉冲发生器时为 1.6 0± 0 .75V(P <0 .0 0 0 1) ,起搏阈值增加的幅度为198.1%± 141.1% ( 2 0 %～ 5 6 7% ) ,增加的绝对值为 1.0± 0 .7( 0 .1～ 3 .0 )V。更换脉冲发生器时 ,起搏电极阻抗 5 5 8.5± 136 .3Ω。更换起搏脉冲发生器后 ,继续使用原心室起搏电极 2 2例。术后随访 48.7± 30 .6 ( 6～ 96 )个月。 2例于更换术后 12 ,2 4个月 (即原心室起搏电极在体内埋置时间分别为 98,12 0个月 )分别出现起搏器感知功能不良。重新手术时发现 ,原心室电极起搏阈值或阻抗增高。其余病人起搏与感知功能均良好。结论 :植入性心室起搏电极使用约 10年后 ,大部分电极的直接测量参数仍在良好范围 ,可以考虑继续使用 ,但必须注意随访 ,定期复查

The Direct Lead Parameters Measurements on Implanted Ventricular Leads in the Patients With Pulse Generator Replacement

We undertook this study to measure the direct lead parameters of implanted ventricular leads in the patents with pulse generator replacement.26 patients with third degree atrioventricular block in 14 and sick sinus syndrome in 12, 15 male and 11 female, mean age 63.9±13.6 years, were involved.Direct lead parameters of implanted ventricular leads that had been implanted for 114.2±27.4 (58～179) months were detected using a pacing system analyzer during pulse generator replacement.Results showed the chronic pacing threshold of leads during pulse generator replacement were higher than initial pacing threshold (1.60±0.75 V vs 0.59±0.27 V, P<0.0001).Chronic pacing threshold of leads during pulse generator replacement were increased by 198.1%±141.1%(20%～567%), with mean increased value of 1.0±0.7(0.1～3.0) V.Chronic lead impedances were 558.5±136.3 Ω during pulse generator replacement. Postoperatively, 22 old leads were continued to perform the pacing function and were followed up for 48.7±30.6 months (6～96 months).Leads malfunction occured in 2 cases of the 22 old leads in 12 months or 24 months after replacement operation, respectively.It is concluded that most direct lead parameters on implanted ventricular leads for near 10 years are within normal ranges, and are considered to continue performing pacing function.Follow up should be taken regularly for those patients.Chinese Journal of Cardiac Pacing and Electrophysiology,2000,14(2):107～109] Cardiac pacing,permanent Ventricle pacing lead Lead parameters measurements,direct