螺旋电极右室流出道间隔部起搏应用研究

目的分析主动固定螺旋电极在右室流出道间隔部起搏中的应用。方法将98例因房室传导阻滞需要安装永久性心脏起搏器的患者随机分成两组,采用主动固定螺旋电极行右室流出道室间隔部起搏术简称主动电极组,应用被动固定电极行右室心尖部起搏术简称被动电极组,记录两组术中及术后的各项参数并进行比较。结果两组均顺利完成手术,未出现严重并发症。主动电极组电极操作曝光时间长于被动电极组;主动电极植入后即刻可以达到理想的起搏阈值,但比被动电极组要高;主动电极组导线阻抗比被动电极组小;两组的感知阈值无明显差别;主动电极组起搏QRS波时限明显短于被动电极组。随访1个月时,两组的起搏阈值无明显差异。术后主动电极组2例出现电极脱位、被动电极组未出现导线脱位。结论主动固定螺旋电极在右室流出道间隔部起搏中是可行的、安全的,关键是熟练掌握置入的方法。

Experience in the Application of Active Fixation Spiral Leads in Patients with Right Ventricular Outflow Tract septum Pacing

Objective To introduce experience in the application of active fixation spiral leads in right ventricular outflow tract(RVOT) septum pacing.Methods 98 patients needed to be implanted with pacemaker were divided into two groups randomly.48 patients underwent the RVOT septum pacing with active fixation spiral leads(active lead group),50 patients underwent the right apical pacing with passive fixation leads(passive lead group).Recorded the parameter of two groups in and after operation and compared accordingly.Results Operations in two groups were accomplished successfully and there were no serious complications.Active lead group took more X-way exposure time to plant leads.After implantation of active lead,it soon reached satisfying Pacing thresholds,higher than Passive lead.The width of QRS complexes in active lead group was narrower than that in passive lead group.But the passive lead group pacing impedance was higher than the active lead group.There was no difference in R wave sensing between two groups.There was no difference between the two groups in pacing thresholds after one month of operation.2 case of lead dislocation happened in the active lead group.Conclusion The usage of active fixation spiral leads in patients in right ventricular outflow tract septum pacing is feasible and safe.The practiced planting method is the key to operation.