经静脉左心室导线的稳定性和长期表现

目的 评估经静脉左心室导线的稳定性和长期表现.方法 研究入选1999年8月至2013年9月在阜外心血管病医院行心脏再同步治疗起搏器/除颤器（CRT-P/CRT-D）更换患者.更换术中应用起搏分析仪直接测量原导线起搏阈值、感知和阻抗,并与首次植入时进行比较.结果 共25例患者成功更换CRT-P/CRT-D（男18例,女7例）,CRT-P更换12例、CRT-D更换13例.更换间隔31～92（60.8）个月.所有左心室导线均经冠状静脉窦植入心脏静脉.首次植入时起搏阈值为0.5～2.5（1.4±0.7） V/0.48 ms,更换时达0.5～5.6（1.8±1.2） V/0.48 ms,差异无统计学意义（P=0.18）.更换时阈值较首次植入降低者6例,降低（1.2±0.5）V/0.48 ms;升高者15例,升高（1.1±1.2）V/0.48 ms;保持不变者4例.阈值变化差值＞2.0 V/0.48 ms者2例（8％）,均升高（1 V/0.48 ms对3.5 V/0.48 ms,0.8 V/0.48 ms对5.6 V/0.48 ms）.后者系本研究中唯一1例起搏阈值＞3.5 V/0.48 ms者.不同型号导线间首次植入、更换时阈值以及阈值变化差值均差异无统计学意义（P＞0.05）.结论 经静脉左心室导线起搏阈值可长期保持稳定,绝大多数在可接受范围.不同型号导线的稳定性相似.

Stability and long-term performance of the transveous left ventricular leads

Objective To evaluate the stability and long-term performance of transveous left ventricular leads.Methods Patients underwent successful replacement of resynchronization device（CRT-P/CRT-D）were enrolled.Pacing parameters of leads were measured using pacing analyzer during the implantation and replacement procedure.Changes in pacing threshold and impedance along with sense were evaluated.Results Between August 1999 and September 2013,25 patients underwent successful replacement of CRT-P/CRT-D in Fuwai Cardiovascular Hospital were enrolled,18 males and 7 females,with CRT-P replacement in 12 cases and CRT-D in 13.Interval between first implantation and replacement was 31-92（60.8） months.Left ventricular leads were implanted through coronary sinus in all the 25 patients.The mean left ventricular lead pacing threshold was 0.5～2.5（1.4±0.7） V/0.48 ms at the initial implantation and changed to （1.8 ± 1.2） V/0.48 ms （0.5-5.6 V/0.48 ms） during replacement.The changing pattern of threshold showed an increasing trend,yet had no significance （P =0.18）.Pacing threshold demonstrated a decrease of（1.2±0.5）V/0.48 ms in 6 cases,an increase of（1.1±1.2） V/0.48 ms in 15 cases and remained stable in 4 cases.Threshold during the replacement procedure was changed by ＞2 V/0.48 ms only in 2 cases when compared to initial implantation.In one case,the threshold changed from 1 V/0.48 ms to 3.5 V/ 0.48 ms,in another,from 0.8 V/0.48 ms to 5.6 V/0.48 ms.The latter case was just the only one case with threshold of more than 3.5 V/0.48 ms.Attain 2187 leads were implanted in 2 cases,Attain OTW 4193 in 18 cases,Corox OTW 75-UP in 3 cases and QuickSite 1056T leads in 2 cases.The initial and replacement threshold as well as changes of the threshold between all 4 type leads were comparable（P＞0.05）.Conclusion Long-term performance of transveous left ventricular lead was stable and favorable with no significant changes in its threshold over nearly 5-year follow-up.This stability was still maintained in vario