Acha Moshe Rav, Keaney John J, Lubitz Steven A, Milan David J, Mansour Moussa, Heist Kevin E, Ptaszek Leon M, Singh Jagmeet P, Blendea Dan, Mela Theofanie
Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston, Massachusetts.
Pacing Clin Electrophysiol. 2015 Mar;38(3):334-42. doi: 10.1111/pace.12550. Epub 2014 Dec 2.
Magnetic resonance imaging (MRI) has been considered contraindicated in patients with cardiac pacemakers (PPMs). Recently, Medtronic (MDT) MRI SureScan PPM (Medtronic Inc., Minneapolis, MN, USA) and leads were introduced into clinical practice in the United States of America.
To compare MDT CapSureFix 5086 MRI SureScan lead-associated perforation and dislodgement rates with MDT non-MRI SureScan active fixation leads.
We retrospectively analyzed the records of all patients implanted with MDT CapSureFix 5086 MRI SureScan leads as well as all patients implanted with MDT 4076 and 5076 leads at our institution from April 2011 to April 2014.
Four of 72 patients implanted with MDT CapSureFix 5086 MRI SureScan leads (5.5%) had evidence of lead perforation, necessitating pericardiocentesis in three cases and lead revision in one case. Three of the four perforations were delayed perforations, presenting more than 3 weeks postimplant. Two patients implanted with MDT CapSureFix 5086 MRI SureScan leads (2.8%) had lead dislodgement. Of 420 patients implanted with MDT non-MRI SureScan leads, there were two perforations (0.47%) and four dislodgements (0.9%). There were significantly increased lead perforations associated with MDT CapSureFix 5086 MRI SureScan leads (P = 0.005) and a nonsignificant trend toward increased dislodgements (P = 0.18) when compared with MDT non-MRI SureScan leads.
In contradiction to prior studies, this retrospective study suggests an increased perforation rate with MDT CapSureFix 5086 MRI SureScan leads. Most perforations were delayed perforations, presenting more than 3 weeks postimplant. Higher volume prospective studies with longer follow-up are needed to confirm our findings.
心脏起搏器（PPM）患者一直被认为禁忌进行磁共振成像（MRI）检查。最近，美敦力（MDT）MRI SureScan PPM（美敦力公司，美国明尼阿波利斯）及其导线已在美国投入临床应用。
比较美敦力CapSureFix 5086 MRI SureScan导线与美敦力非MRI SureScan主动固定导线相关的穿孔和脱位发生率。
我们回顾性分析了2011年4月至2014年4月在我院植入美敦力CapSureFix 5086 MRI SureScan导线的所有患者以及植入美敦力4076和5076导线的所有患者的记录。
72例植入美敦力CapSureFix 5086 MRI SureScan导线的患者中有4例（5.5%）有导线穿孔证据，3例需要进行心包穿刺，1例需要更换导线。4例穿孔中有3例为延迟穿孔，在植入后3周以上出现。2例植入美敦力CapSureFix 5086 MRI SureScan导线的患者（2.8%）发生导线脱位。在420例植入美敦力非MRI SureScan导线的患者中，有2例穿孔（0.47%）和4例脱位（0.9%）。与美敦力非MRI SureScan导线相比，美敦力CapSureFix 5086 MRI SureScan导线相关的穿孔明显增加（P = 0.005），脱位有增加趋势但无统计学意义（P = 0.18）。
与先前的研究相反，这项回顾性研究表明美敦力CapSureFix 5086 MRI SureScan导线的穿孔率增加。大多数穿孔为延迟穿孔，在植入后3周以上出现。需要进行更大规模、随访时间更长的前瞻性研究来证实我们的发现。
