单根直钢丝与双钢丝技术置人心室起搏电极的对比研究

目的评价单根直钢丝技术在置入心室起搏电极操作中的价值。方法将60例患者随机分为单根直钢丝组和双钢丝交换组,均采用右侧静脉途径置入普通单极心室电极导线。单根直钢丝组(30例) 置入方法为：①将心室电极送至右心房中部,回撤钢丝5cm左右；②在右心房中下部快速抖动式进退电极；③当电极头端越过三尖瓣口时,推送钢丝至电极头端,并前送至右室心尖部。双钢丝交换组(30例)按常规方法进行。若各组透视时间超过20min电极定位不成功,则互相交换操作方法。结果单根直钢丝组操作时间为(16.03±4.00)min、透视时间为(23.47±5.72)min,明显短于双钢丝交换组(9.13±2.50)min vs (14.10±3.82)min(P＜0.05)；单根直钢丝组和双钢丝组分别有4例、3例在交换操作方法后将电极定位成功。双钢丝交换组有4例缠绕希阿里网,3例误入冠状静脉窦。两组患者分别随访(2.31±1.05)年和(2.20± 1.28)年,起搏功能正常。结论置入心室电极时,单根直钢丝技术比双钢丝交换技术操作简单、更能快速准确到达右室心尖部。

Comparative study on ventricular pacing lead implantation between single straight stainless wire procedure and double wire exchange technique

Objective To evaluate the value of single straight stainless wire technique in the implantation of ventricular pacing electrode lead.Methods Sixty patients were randomized into single straight wire (SSW) group and double wire exchange(DWE)group.Ordinary unipolar ventricular lead was implanted via right superior vena cava approach in two groups.The lead implantation step in SSW group (30 cases) was following: ①advancing the ventricular lead to the right atrial middle and evacuating the wire 5 cm. ②advancing and retreating the electrode lead quickly in the mid-inferior parts of atrium. ③advancing the wire to the lead tip and inserting the wire and lead together to the right ventricular apex when the lead tip through the tricuspid valve. The lead was implanted by standard procedure in DWE group (30 cases). Two approachs were changed each other if fluoroscopy time was more than 20 min.Results The lead implantation time and fluoroscopy time of SSW group were significantly less than those of DWE group (16.03±4.00 vs 23.47±5.72min vs 9.13±2.50 vs 14.10±3.82min, P＜0.05). There were 4 cases of pacing lead's catching by Chiari network and 3 cases of pacing lead's enter coronary vein in DEW group. Two groups were followed up respectively 2.31±1.5years (SSW) and 2.20±1.28 years (DEW) with normal pacemaker function. Conclusion In the implantation of ventricular pacing lead, SSW technique has the advantages of simpler procedure steps, less fluoroscopy time and more accurately anchoring the lead tip into the right ventricular apex than DWE skill.