被动起搏电极参数随访分析

【作者】 赖卫国；

【导师】 方全；

【作者基本信息】 中国协和医科大学 ， 内科学， 2008， 硕士

【摘要】 研究背景:起搏电极一直是起搏治疗最脆弱的环节,起搏器在其功能、大小以及寿命上的进展都是基于起搏电极的发展上的。目前起搏电极的主要问题仍围绕在优良的电学特性以及组织相容性上。高阻抗、小直径激素释放绝缘电极已经成为当前起搏电极的主流。研究目的:了解激素释放被动电极置入后的参数变化;评估其安全性和有效性。方法:对我院2005年10月至2008年4月间91例植入起搏器患者的三种被动起搏电极进行随访,其中心房被动电极83根,心室被动电极85根。回顾性分析置入当时、术后3月和1年的电极感知与起搏阈值,评价其动态变化。结果:同置入时比,术后3月三种电极心房起搏阈值均无统计学变化(P＞0.05);Biotronik电极心房感知由3.70±1.46 mV降至2.44±0.30 mV(P=0.001),Ela及Medtronic电极心房感知无统计学变化(P＞0.05);Biotronik心室电极起搏阈值由0.35±0.13 V升至0.17±0.23 V(P=0.003),Ela心室电极起搏阈值由0.58±0.24 V升至0.89±0.25 V(P＜0.001),Medtronic心室电极起搏阈值无统计学变化(P＞0.05);Biotronik心室电极感知由9.74±1.93 mV升至14.6±5.50 mV(P=0.015),Medtronic心室电极感知由11.29±4.38 mV升至15.42±5.43 mV(P=0.010),ela电极则无统计学变化(P＞0.05)。同置入时比,术后1年三类电极心房起搏阈值、心房感知、心室感知均无统计学变化(P＞0.05);Biotronik心室电极起搏阈值由0.44±0.21V升至0.63±0.28 V(P=0.035),Medtronic心室电极起搏阈值由0.48±0.26 V升至0.78±0.33V(P=0.031),ela电极则无统计学变化(P＞0.05)。1例患者出现术后电极脱位,再次手术后工作正常,未发现其它电极相关并发症。结论:激素被动固定电极置入1年内能保持较低的起搏阈值及良好的感知度。更多还原

【Abstract】 Background:Cardiac pacing lead is always the weakest aspect of the cardiac pacing therapy,the advances concerning the functionality,size,and longevity of cardiac pacemakers depend on concomitant advances in cardiac pacing leads.The current state of affairs of cardiac pacing leads are focusing on excellent electrical properties and histocompatibility.High impedance,small diameter and steroid-eluting leads are the common choices in clinical practice.Objective:To evaluate and compare the steroid-eluting leads from different companies implanted in the past two years at Peking Union Medical College Hospital.Method:Three different brands of steroid-eluting leads were randomly selected and implanted in 91 patients from Nov,2005 to Apr,2008,which include 83 atrial leads and 85 ventricular leads.Patients were followed at 3 and 12 months after implantation.Pacing and sensing thresholds and lead impedance were measured at the time of implantation and each follow-up.All the records were analyzed retrospectively and compared.Results:At the first 3 months follow-up after implantation,atrial pacing thresholds revealed no significant difference(P＞0.05) in all brands of leads, compared to the records at the time of implantation.Biotronik atrial sensing thresholds reduced from 3.70±1.46 mV to 2.44±0.30 mV(P=0.001),while Ela and Medtronic showed no significant differences(P＞0.05).Biotronik ventricular pacing thresholds risen from 0.35±0.13 V to 0.17±0.23 V(P=0.003),Ela ventricular pacing thresholds risen from 0.58±0.24 V to 0.89±0.25 V (P＜0.001),but Medtronic revealed no significant differences(P＞0.05). Biontronik ventricular sensing thresholds risen from 9.74±1.93 mV to 14.6± 5.50 mV(P=0.015),Medtronic ventricular sensing thresholds risen from 11.29±4.38 mV to 15.42±5.43 mV(P=0.010),however,Ela remains no change statistically(P＞0.05).Compared to the records at the time of implantation,all the leads showed no significant difference in atrial pacing and sensing thresholds as well as ventricular sensing thresholds 12 months after implantation(P＞0.05).Biotronik ventricular pacing thresholds risen from 0.44±0.21V to 0.63±0.28 V(P=0.035),Medtronic ventricular pacing thresholds risen from 0.48±0.26 V to 0.78±0.33V(P=0.031),while Ela revealed no significant changes(P＞0.05).One patient suffered from lead dislocation but no other complications were identified during the follow-up.Conclusion:The three different kinds of steroid-eluting leads evaluated in this study revealed stable parameter variation with a reliable clinical effect.更多还原