Department of Electrocardiology, Institute of Cardiology, Jagiellonian University School of Medicine, The John Paul II Hospital in Krakow, Krakow, Poland.
Kardiol Pol. 2011;69(10):1033-40.
Venous obstruction and subsequent pulmonary embolism belong to the most common and dangerous complications of pacemaker implantation. Thus, identification of patients at risk of venous obstruction seems to be of critical importance.
To determine risk factors of venous obstruction following pacemaker implantation.
Eighty one patients with permanent cardiac pacing (31 F, 50 M; mean age 71.1 ± 7.6 years) were included. Prior to pacemaker implantation, the following factors were evaluated in each patient: indications for pacemaker implantation, heart failure severity assessed using the NYHA classification, coexisting diseases, a history of tobacco smoking, medications used before the procedure (antiplatelet drugs, anticoagulants, antibiotics), a history of thrombotic or infectious complications, and previous temporary cardiac pacing. Type of venous access and procedure time were also assessed. Venous ultrasound examination to evaluate veins in both upper extremities, shoulder areas and the neck was performed before pacemaker implantation and 6 and 12 months following the procedure. Computed tomography and conventional digital subtraction angiography were performed to confirm the diagnosis of venous obstruction.
The patients were divided into two groups based on the occurrence of venous obstruction after pacemaker implantation. Group I (n = 71, 29 F, 42 M; mean age 71.0 ± 7.7 years) included patients without venous obstruction, and group II (n = 10, 2 F, 8 M; mean age 71.6 ± 7.0 years) included patients diagnosed with venous obstruction. Each patient was followed for 19 months. In group II (12.3% of the study population), venous obstruction developed mean 13 months after pacemaker implantation. In this group, symptomatic venous obstruction was observed in 3 patients (3.7% of the study population), mean 15 months after pacemaker implantation. Risk factors for venous obstruction included a history of myocardial infarction, temporary cardiac pacing, arrhythmia, venous anomalies, NYHA class III and IV heart failure, a history of infection, and tobacco smoking. Depending on the number of risk factors, the probability of development of venous obstruction was described by the following equation: e(-14.6 + 3.19x)/1 + e(-14.6 + 3.19x), where x is the number of risk factors. In patients who had more than 6 risk factors, almost a 100% probability of the occurrence of venous obstruction was observed.
静脉阻塞和随后的肺栓塞属于心脏起搏器植入后最常见和最危险的并发症。因此，识别有静脉阻塞风险的患者似乎至关重要。
确定心脏起搏器植入后静脉阻塞的危险因素。
共纳入 81 例永久性心脏起搏患者（31 例女性，50 例男性；平均年龄 71.1±7.6 岁）。在植入起搏器之前，对每位患者评估以下因素：植入起搏器的指征、纽约心脏协会（NYHA）分级评估的心力衰竭严重程度、并存疾病、吸烟史、术前使用的药物（抗血小板药物、抗凝药物、抗生素）、血栓或感染性并发症史以及既往临时心脏起搏。还评估了静脉入路类型和手术时间。在植入起搏器之前以及之后 6 个月和 12 个月，对双侧上肢、肩部和颈部的静脉进行超声检查。通过计算机断层扫描和常规数字减影血管造影术确认静脉阻塞的诊断。
根据心脏起搏器植入后是否发生静脉阻塞，将患者分为两组。组 I（n=71，29 例女性，42 例男性；平均年龄 71.0±7.7 岁）包括无静脉阻塞的患者，组 II（n=10，2 例女性，8 例男性；平均年龄 71.6±7.0 岁）包括诊断为静脉阻塞的患者。每位患者随访 19 个月。组 II（研究人群的 12.3%）在心脏起搏器植入后 13 个月出现静脉阻塞。在该组中，3 例（研究人群的 3.7%）在心脏起搏器植入后 15 个月出现有症状的静脉阻塞。静脉阻塞的危险因素包括心肌梗死史、临时心脏起搏、心律失常、静脉异常、NYHA 心功能分级 III 级和 IV 级、感染史和吸烟。根据危险因素的数量，静脉阻塞发生的概率用以下公式描述：e(-14.6+3.19x)/1+e(-14.6+3.19x)，其中 x 是危险因素的数量。在有超过 6 个危险因素的患者中，几乎 100%发生静脉阻塞。
1.静脉阻塞的危险因素包括心肌梗死史、临时心脏起搏、心律失常、静脉异常、感染、NYHA 心功能分级 III 级和 IV 级以及吸烟史。2.在有超过 6 个危险因素的患者中，静脉阻塞的风险几乎为 100%。
