低位房间隔起搏的临床应用

目的行低位房间隔(LAS,Koch三角处)起搏并与右心耳(RAA)起搏进行比较和评价。方法60例需置入DDD起搏器的患者,随机分为RAA起搏组和LAS起搏组各30例,其中LAS组先将主动螺旋固定电极导线放置在RAA测量起搏参数后再将其植入LAS,而RAA组则用被动翼状电极导线直接固定在RAA。分别测量不同部位的起搏参数,比较手术成功率、X线曝光时间、术中及术后脱位率。结果两个部位的起搏电压阈值、阻抗无明显差别,但腔内P波振幅LAS明显高于RAA(3.8±0.7 mV vs 2.2±0.8 mV),LAS起搏的P波宽度明显短于RAA起搏的P波宽度(88±18 ms vs 154±37 ms)。与RAA组相比,LAS组的手术成功率偏低(90%vs 100%),手术曝光时间亦明显延长(128±45 s vs 12±4 s),术中脱位率在低位房间隔明显高于右心耳(33.3%vs 0%)。结论LAS起搏是可行的,能较RAA起搏明显缩短心房激动时间,但植入手术较传统RAA起搏复杂。

Application of low atrial septal pacing.

Objective To evaluate the feasibility and safety of low atrial septal （ LAS, the region of Koch triangle ） pa- cing compared with the routine right atrial auricle （RAA） pacing. Methods Sixty patients who applied DDD pacemak- er were randomized equally into RAA and LAS pacing groups. In the LAS pacing group, active fixation lead was used to lo- cate to the site of RAA followed by screwing in the site of LAS. The difference in the pacing parameters, lead implantation success rate, X ray exposure time and dislocation rate during and after operation were investigated. Results （1）Pacing parameters：there were no difference in pacing threshold and impedance between two pacing sites. However, compared with RAA pacing site, the amplitude of P wave was higher （3.8 ± 0.7 mV vs 2.2 ± 0.8 mV） and width of pacing P wave was narrower （88 ± 18 ms vs 154 ±37 ms） in LAS pacing site. （2）Lead implantation success rate and X ray exposure time ： the success rate of LAS was a little lower than RAA group （90% vs 100% ,P〉0.05） , and the X ray exposure time in LAS site was much longer than RAA site（128 ±45 s vs 12 ±4 s ）. （3）Lead dislocation： during operation the lead dislocation of LAS and RAA site were 33.3% and 0% （ P 〈 0.05 ）, respectively. Two eases of LAS group were found atrial lead dislocation during follow up, while no dislocation was in RAA group. Conclusion LAS pacing is feasible and markedly short- ens biatrial activation times though the fixation to the LAS is more complicated compared with RAA pacing. Chinese Jour- nal of Cardiac Pacing and Electrophysiology ,2009,23 （ 1 ） ： 19 - 22 ]