Garnreiter Jason, Whitaker Patricia, Pilcher Thomas, Etheridge Susan, Saarel Elizabeth
Department of Pediatrics, Saint Louis University School of Medicine, St. Louis, Missouri.
Pacing Clin Electrophysiol. 2015 Jan;38(1):42-7. doi: 10.1111/pace.12508. Epub 2014 Sep 16.
Pediatric and congenital heart disease (CHD) patients requiring permanent pacing present unique challenges, including need for long duration of implant, small size, and structural abnormalities. We report 6 years of experience with a novel 4.1-Fr lumenless pacing lead (model 3830, Medtronic Inc., Minneapolis, MN, USA) in this population.
Retrospective review of M3830 leads implanted at a pediatric center from 2005 to 2011. Data were compared to a population with a conventional pacing lead (model 1488, St. Jude Medical Inc., St. Paul, MN, USA).
A total of 193 patients with 198 model 3830 leads (125 atrial, 73 ventricular) were enrolled. CHD was present in 121 (63%). Age and weight at implant were 16.6 ± 8.5 years and 51.7 ± 23.5 kg, respectively. Length of follow-up was 26 ± 19 months (range 0-73). At implant, mean sensing and capture thresholds were good and remained stable over time. There were no significant differences in electrical performance compared to 101 leads in the comparison group. Implant complications were rare. Follow-up complications occurred in 4% of the M3830 leads and 16% of M1488 leads. Eleven M3830 leads required extraction. All were extracted without complications using only manual traction. There were three deaths in each group. One death in the M1488 group occurred during lead extraction. No other deaths were lead related.
During up to 6 years of use in pediatric and CHD patients, the M3830 lead has demonstrated excellent efficacy, a low rate of complications, and straightforward extractability relative to traditional pacing leads.
需要永久起搏的儿科和先天性心脏病（CHD）患者面临着独特的挑战，包括植入时间长、体型小以及结构异常等。我们报告了在这一人群中使用新型4.1法国规格无腔起搏导线（型号3830，美敦力公司，美国明尼苏达州明尼阿波利斯）6年的经验。
对2005年至2011年在一家儿科中心植入的M3830导线进行回顾性研究。将数据与使用传统起搏导线（型号1488，圣犹达医疗公司，美国明尼苏达州圣保罗）的人群进行比较。
共纳入193例患者，植入198根型号3830导线（125根心房导线，73根心室导线）。121例（63%）患有CHD。植入时的年龄和体重分别为16.6±8.5岁和51.7±23.5千克。随访时间为26±19个月（范围0 - 73个月）。植入时，平均感知和夺获阈值良好，且随时间保持稳定。与对照组的101根导线相比，电性能无显著差异。植入并发症罕见。随访并发症在M3830导线中发生率为4%，在M1488导线中为16%。11根M3830导线需要拔除。所有导线仅通过手动牵引拔除，无并发症发生。每组均有3例死亡。M1488组有1例死亡发生在导线拔除期间。无其他死亡与导线相关。
在儿科和CHD患者中使用长达6年期间，M3830导线相对于传统起搏导线显示出卓越的疗效、低并发症发生率以及易于拔除的特点。
