主动固定导线行右心室流出道间隔部起搏的临床应用

目的：探讨采用主动固定导线行右心室流出道（RVOT）间隔部起搏的可行性和安全性。方法：需安置体内埋藏式心脏起搏器的患者120例行RVOT间隔部起搏,根据心室是否依赖起搏分为心室起搏依赖组（48例）和心室起搏非依赖组（72例）,记录两组术中、术后的各项参数及术后起搏导管的稳定性并进行比较。结果：两组均顺利完成手术,未出现严重并发症。两组及亚组分析显示手术时间、X线曝光时间、囊袋形成耗时、寻找头静脉耗时及心室起搏参数差异均无显著性（P〉0.05）。非依赖组主动导线置入即刻起搏阈值及阻抗明显升高,15 min后可达到理想阈值。两组术后1、3个月随访,心室起搏参数与置入时差异均无显著性（P〉0.05）。心室起搏依赖组在术后3 d发生心房被动导线脱位1例,2组RVOT主动固定导线在术后3～12个月的随访中未见脱位。结论：不论心室起搏依赖或非依赖者,使用主动固定导线行RVOT间隔部起搏安全可行。

Clinical application of pacing at the septel portion of the tright ventricular outflow tract

Objective：To explore the feasibility and security of right ventricular outflow tract（RVOT） ventricular septal pacing using the active fixed lead.Methods：One hundred and twenty patients implanted with pacemaker were separated into two groups according to whether the ventricular relied on pacing or no：①dependent on ventricular pacing group：48 patients,aged 68.75±13.58（40～96）years old,including thirty men and eighteen women,②No-dependent on ventricular pacing group：72 patients,aged 65.01±11.90（14～88）years old,including forty six men and twenty six women.Recorded the parameter of two groups in and after the operation and the stability of the postoperatire pacing lead of two groups was compared.Results：Operations in two groups were accomplished smoothly and no severe complications occurred.There was no difference between the procedure time,x-ray expesure time,times of fixation,pacing threshold,R wave sensing and pacing impedance.But pacing threshold and pacing impedance were significantly higher in immediately implantation than those after 15 minutes implantation.After 15 minutes implantation,it reached perfect pacing parameter.The pacing parameter did not change after one and three months’ operation.The dependent ventricular pacing group had 1 case of atrial wire dislocation after three days’ operation.RVOT of active fixed lead did not occur wire dislocation in follow-up 10.5±3.7（3～18） months after operation.Conclusion：It is feasible and safe that to use pacing from RVOT septum with active lead whether who is dependent or is not dependent on or ventricular pacing patient.