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心脏再同步治疗中高位后间隔和心尖部导线置入时的右心室起搏与感知功能

Right ventricular pacing and sensing function in high posterior septal and apical lead placement in cardiac resynchronization therapy.

作者信息

Kristiansen Hm, Hovstad T, Vollan G, Faerestrand S

机构信息

Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.

出版信息

Indian Pacing Electrophysiol J. 2012 Jan;12(1):4-14. doi: 10.1016/s0972-6292(16)30458-2. Epub 2012 Jan 31.

DOI:10.1016/s0972-6292(16)30458-2
PMID:22368376
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3273951/
Abstract

BACKGROUND

The conventional right ventricular (RV) lead position in cardiac resynchronization therapy pacemakers (CRT-P) is the RV apex (RV-A). Little is known about electrophysiological stability and associated complications of pacing leads in RV high posterior septal (RV-HS) position in CRT-P.

METHODS

Two hundred and thirty-five consecutive CRT-P patients were included from 1999-2010. Pacing thresholds at 0.5ms and 2.5V, sensing electrograms and lead impedances were measured at implant and repeated 1,3,6,12,18 and 24 months after CRT-P. Electrophysiological measurements of leads located in RV-A and RV-HS were analyzed retrospectively. Bipolar RV leads were used, including high impedance leads, passive fixation and active fixation.

RESULTS

RV pacing leads were implanted in RV-A (n=79) and RV-HS (n=156). Average RV pacing thresholds from CRT implant procedure to 24-month follow-up at 0.5ms were 0.77±0.69V in RV-A and 0.71±0.35V in RV-HS (P=0.31), and at 2.5V were 0.06±0.08ms in RV-A and 0.07±0.05ms in RV-HS (P=0.12). Average RV electrogram amplitudes from baseline to 24 months after CRT were 15.3±6.9mV in RV-A and 12.1±6.0mV in RV-HS (P=0.55). Average RV impedances during follow-up were 850±286Ω in RV-A and 618±147Ω in RV-HS (P=0.57). Similar RV lead revisions between RV-A and RV-HS were observed after 2-year follow-up (P=0.55).

CONCLUSION

The RV-HS lead position demonstrated stable and acceptable long-term pacing and sensing function, with rates of complications comparable to conventional RV-A lead position in CRT. The RV-HS lead position is feasible in CRT-P.

摘要

背景

心脏再同步治疗起搏器（CRT-P）中传统的右心室（RV）导联位置是右心室心尖部（RV-A）。关于CRT-P中右心室高后间隔（RV-HS）位置起搏导线的电生理稳定性及相关并发症，人们了解甚少。

方法

纳入1999年至2010年连续的235例CRT-P患者。在植入时及CRT-P植入后1、3、6、12、18和24个月测量0.5ms和2.5V时的起搏阈值、感知电图和导线阻抗。对位于RV-A和RV-HS的导线的电生理测量进行回顾性分析。使用双极RV导线，包括高阻抗导线、被动固定和主动固定导线。

结果

RV起搏导线分别植入RV-A（n = 79）和RV-HS（n = 156）。从CRT植入手术到24个月随访，0.5ms时RV-A的平均RV起搏阈值为0.77±0.69V，RV-HS为0.71±0.35V（P = 0.31）；2.5V时，RV-A为0.06±0.08ms，RV-HS为0.07±0.05ms（P = 0.12）。从基线到CRT后24个月，RV-A的平均RV电图振幅为15.3±6.9mV，RV-HS为12.1±6.0mV（P = 0.55）。随访期间，RV-A的平均RV阻抗为850±286Ω，RV-HS为618±147Ω（P = 0.57）。两年随访后，RV-A和RV-HS之间观察到相似的RV导线修订率（P = 0.55）。

结论

RV-HS导线位置显示出稳定且可接受的长期起搏和感知功能，并发症发生率与CRT中传统的RV-A导线位置相当。RV-HS导线位置在CRT-P中是可行的。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3919/3273951/4f050a10f251/ipej120004-06.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3919/3273951/c052ebc0ed9f/ipej120004-01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3919/3273951/82a346891e24/ipej120004-02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3919/3273951/21f6aebca673/ipej120004-03.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3919/3273951/ce65bc6204a4/ipej120004-04.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3919/3273951/f0d52c203255/ipej120004-05.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3919/3273951/4f050a10f251/ipej120004-06.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3919/3273951/c052ebc0ed9f/ipej120004-01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3919/3273951/82a346891e24/ipej120004-02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3919/3273951/21f6aebca673/ipej120004-03.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3919/3273951/ce65bc6204a4/ipej120004-04.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3919/3273951/f0d52c203255/ipej120004-05.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3919/3273951/4f050a10f251/ipej120004-06.jpg

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