Chakrabarti Santabhanu, Morgan Gareth J, Kenny Damien, Walsh Kevin P, Oslizlok Paul, Martin Robin P, Turner Mark S, Stuart A Graham
Bristol Congenital Cardiac Centre, Bristol Royal Hospital for Children, Bristol, UK.
Pacing Clin Electrophysiol. 2009 Nov;32(11):1428-33. doi: 10.1111/j.1540-8159.2009.02487.x. Epub 2009 Sep 21.
Long-term pacing is frequently necessary in patients with congenital heart disease (CHD). Preservation of ventricular function and avoidance of venous occlusion is important in these patients. Site-selective pacing with a smaller diameter lead is achievable with the model 3830 lead (SelectSecure, Medtronic Inc., Minneapolis, MN, USA), which was specifically designed to target these complications. We describe our initial experience with the Model 3830 lead in patients with CHD.
Retrospective analysis of all patients undergoing site-selective implantation of a Model 3830 lead(s) from two congenital heart centers (Bristol, UK, and Dublin, Ireland) from October 2004 until February 2008.
We implanted 139 SelectSecure leads (atrial n=70; ventricular n=69) in 90 patients (57 male) with CHD. Median age at implantation: 13.4 years (1.1-59.2 years), median weight: 43 kg. Sixty-nine patients (76%) were children (<18 years). Indications for lead implantation included atrioventricular block (n=55), sinus node disease (n=18), implantable cardiac defibrillator (n=12), antitachycardia pacing (n=4), and cardiac resynchronization (n=1). Twenty-two patients underwent pre-existing lead extraction during the same procedure. All the attempted procedures resulted in successful pacing. One patient had a significantly raised threshold at implantation. There was no procedural mortality. There were two procedural complications. Three patients required lead repositioning for increasing thresholds early postprocedure (<6 weeks). Four leads (2.9%) had displaced on median follow-up of 21.8 months (0.5-42 months).
The Model 3830 lead is safe and effective in patients with CHD. This is a technically challenging patient group yet procedural complication and lead displacement rates are acceptable.
先天性心脏病（CHD）患者常常需要长期起搏治疗。对于这些患者而言，维持心室功能以及避免静脉阻塞至关重要。采用直径较小的导线进行部位选择性起搏可通过3830型导线（SelectSecure，美敦力公司，美国明尼苏达州明尼阿波利斯）实现，该导线是专门针对这些并发症设计的。我们描述了3830型导线在CHD患者中的初步应用经验。
对2004年10月至2008年2月期间在两个先天性心脏病中心（英国布里斯托尔和爱尔兰都柏林）接受3830型导线部位选择性植入的所有患者进行回顾性分析。
我们为90例（57例男性）CHD患者植入了139根SelectSecure导线（心房导线n = 70；心室导线n = 69）。植入时的中位年龄为13.4岁（1.1 - 59.2岁），中位体重为43千克。69例患者（76%）为儿童（<18岁）。导线植入的适应证包括房室传导阻滞（n = 55）、窦房结疾病（n = 18）、植入式心脏除颤器（n = 12）、抗心动过速起搏（n = 4）以及心脏再同步治疗（n = 1）。22例患者在同一手术过程中进行了原有导线拔除。所有尝试的手术均成功实现起搏。1例患者在植入时阈值显著升高。无手术死亡病例。有2例手术并发症。3例患者在术后早期（<6周）因阈值升高需要重新调整导线位置。在中位随访21.8个月（0.5 - 42个月）时，4根导线（2.9%）发生移位。
3830型导线在CHD患者中安全有效。这是一个技术上具有挑战性的患者群体，但手术并发症和导线移位率是可以接受的。
