Stojanov Petar L, Savic Dragutin V, Zivkovic Mirjana B, Calovic Zarko R
Institute for Cardiovascular Diseases, Clinical Center of Serbia, Pacemaker Center, Belgrade, Serbia.
Pacing Clin Electrophysiol. 2008 Sep;31(9):1100-7. doi: 10.1111/j.1540-8159.2008.01148.x.
The aim of the study was to analyze endovenous pacing lead survival in pediatric population implanted by cephalic cut down, or by axillary vein puncture.
All implantations were performed in total endotracheal anesthesia, by the same surgeon. Implantations of ventricular leads were performed by cephalic vein cut down or by external jugular vein preparation. In dual-chamber pacing, atrial leads were implanted via cephalic vein (along with ventricular lead), by axillary vein puncture or via external jugular vein. All implanted leads were secured by resorbable suture.
Over the 20-year follow-up period, 105 children of 5.7 years average age (range 1 day-15 years) were implanted with a permanent endovenous pacing system for congenital or postsurgical complete atrioventricular block or sinus node disease. Within the group, 27 patients (25.7%) weighed less than 10 kg on implantation. A total of 121 endovenous leads were implanted. All ventricular leads were with a passive fixation mechanism, and most of them unipolar (87.6%) and steroid eluting (94.2%). Leads implanted in atrial position were 82% bipolar, predominantly with active fixation (94%), and all steroid eluting. The most frequently used mode of stimulation was VVIR (66.6%). No acute or chronic lead displacement, exit block, sensing problem, lead conductor fracture, insulation defect or infections were observed during the total follow-up of 709 pacing years (average 6.9, range 0-20 years).
Implantation of the endovenous leads by preparation of the cephalic or puncture of the axillary vein, with lead fixation by resorbable suture represents a method of choice.
本研究旨在分析通过头静脉切开或腋静脉穿刺植入的儿科患者静脉内起搏导线的存活情况。
所有植入手术均在全身气管内麻醉下由同一位外科医生进行。心室导线的植入通过头静脉切开或颈外静脉准备完成。在双腔起搏中，心房导线通过头静脉（与心室导线一起）、腋静脉穿刺或颈外静脉植入。所有植入的导线均用可吸收缝线固定。
在20年的随访期内，105名平均年龄5.7岁（范围1天至15岁）的儿童因先天性或术后完全性房室传导阻滞或窦房结疾病植入了永久性静脉内起搏系统。该组中，27例患者（25.7%）植入时体重不足10kg。共植入了121根静脉内导线。所有心室导线均采用被动固定机制，其中大多数为单极（87.6%）且带类固醇洗脱功能（94.2%）。植入心房位置的导线82%为双极，主要采用主动固定（94%），且均带类固醇洗脱功能。最常用的刺激模式是VVIR（66.6%）。在709个起搏年（平均6.9年，范围0至20年）的总随访期间，未观察到急性或慢性导线移位、出口阻滞、感知问题、导线导体断裂、绝缘缺陷或感染。
通过头静脉准备或腋静脉穿刺植入静脉内导线，并采用可吸收缝线固定导线是一种首选方法。
