不同起搏导线植入术中的损伤电流特征

目的明确不同起搏导线在植入过程中产生的损伤电流（COI）形态及变化特征。方法经起搏分析仪及体表心电图仪同步记录右心室螺旋及翼状导线、左心室心脏静脉导线及埋植多年的右心室起搏导线产生的腔内心电图（ICEG），动态观察其形态及COI变化特征。COI大小指标包括J点后80ms处的ST段振幅（ST80），ST80与自身R波振幅之比（ST80／R）以及ICEG时限（IED）。结果共记录81根起搏导线的ICEG，包括48根螺旋导线、21根翼状导线、6根左心室心脏静脉导线和6根埋植多年的起搏导线。两种方法均记录到螺旋及翼状导线产生的COI；起搏分析仪描记的螺旋导线固定10min的sT80（7．7±2．7）mV对（5．1±0．6）mV]，ST50／R（0．62±0．24）对（0．54±0．07）]及IED（233．6±33．7）ITIS对（211．5±29．3）ms]与固定0min相比，差异无统计学意义（P〉0．05）；而翼状导线固定10min的ST80（5．6±2．8）mV对（0．8±0．6）mV，P〈0．01]，ST80／R（0．39±0．12）对（0．01±0．01），P〈0．os3及IED（145．4±79．4）ms对（64．3±19．8）ms，P〈0．01）]与固定0min相比大幅减小，且大部分时间点的ST孙ST80／R值均较螺旋导线的相应值小（P〈0．05）。总体上，体表心电图仪记录到相似的COI变化趋势。左心室心脏静脉导线及埋植多年的起搏导线均无CO／产生。结论螺旋导线与翼状导线相比，COI值较大，持续时间较长。左心室心脏静脉导线及埋植多年的起搏导线不产生COI。

Characteristics of current of injury in permanent pacemaker lead implantation

Objective To investigate the characteristics and dynamic behaviors of current of injury （COI） observed during pacemaker lead implantation. Methods Intracardiac electrogram （ICEG） was recorded simultaneously by pacing system analyzer and conventional 12-lead surface electrocardiogram for up to 10 rains after successful lead placement.Presence of COI was characterized as elevation of ST segment and prolon- gation of ICEG duration（IED） .COI Parameters,including STs0（ amplitude of ST segment elevation at 80 ms af- ter J point） ,STs0/R（ STs0 divided by intrinsic R wave amplitude） and IED associated with active and passive- fixation leads were measured dynamically at 0,2,5 and 10 min post lead fixation.Left ventricular（LV） coronary venous leads and those leads fixed years ago were studied as well.Pacing parameters of each pacing lead were e- valuated routinely after the procedure. Results Total of 48 active-fixation leads and 21 passive fixation leads were studied, each of them showed ICEG with distinct COI.The COI magnitude of active fixation leads acquired by pacing system analyzer was maintained at a considerable level without remarkable decrease within 10 min after lead fixation： （（7.7±2.7） mV vs.（5.1±0. 6） mV3 for STs0, （ （0. 62±0. 24） vs.（0. 54±0.07） 3 for STs0/ R and（（233.6±33.7） ms vs.（211.5±29.3） ms3 for IED（ 10 min vs.0 min,P〉0. 05）.The passive-fixation leads presented relatively less pronounced STs0and ST80/R at most of the time points（passive vs.active,P〈0. 05）,and notable decline in COI magnitude,including ST80 （5.6±2. 8） mV vs. （0. 8±0. 6） mV ,P〈0. 011, STso/R （0. 39±0. 12） vs.（0.01±0.01） ,P〈0.05 ） and IED （145.4±79.4） ms vs.（64.3±19.8） ms,P〈0.01 ] ,oc- curred within 10 minutes of observation（ 10 min vs.0 min）.In general, the surface electrogram showed similar findings.Neither left ventricular coronary venous leads nor those leads in the cases of pacemaker replacement showed significant COl. All implanted leads yield acceptable pacing parameters. Conclusion Active-fixation leads were related to COI of greater magnitude and longer time course compared to passive-fixation leads.IN coronary venous leads as well as the leads implanted years ago produced ICEG without COI.