Khanal J, Poudyal R R, Devkota S, Thapa S, Dhungana R R
Department of Cardiology, Manmohan Cardiothoracic Vascular and Transplant Centre, Kathmandu, Nepal.
Nepal Family Development Foundation, Kathmandu, Nepal.
J Nepal Health Res Counc. 2015 May-Aug;13(30):138-43.
Permanent pacemaker implantation is a minimally invasive surgical procedure in the management of patients with cardiac problems. However, complications during and after implantation are not uncommon. There is lack of evidences in rate of complications with the selection of pacemakers in Nepal. Therefore, this study was performed to compare the frequency of implantation and complication rate between single chamber and dual chamber pacemaker.
The present study is based on all consecutive pacemaker implantations in a single centre between April 2014 and May 2015. A total of 116 patients were categorized into two cohorts according to the type of pacemaker implanted- single chamber or dual chamber. All patients had regular 2-weeks follow-up intervals with standardized documentation of all relevant patient data till 6-week after implantation. Data were presented as means ± standard deviation (SD) for continuous variables and as proportions for categorical variables. Comparison of continuous variables between the groups was made with independent Student's t-test. For discrete variables distribution between groups were compared with Chi-square test.
The mean age (±SD) of total population at implant was 64.08 (± 15.09) years. Dual chamber units were implanted in 44 (37.93%) of patients, single chamber in 72 (62.06%). Only 14 women (31.81%) received dual chamber compared with 42 women (58.33%) who received single chamber (Chi-square=18, DF=1, P = 0.0084). Complete atrioventricular block was the commonest (56.03%) indication for permanent pacemaker insertion followed by sick sinus syndrome (33.62%), symptomatic high-grade AV block (11.20%). Hypertension (dual chamber 21.55%, single chamber 40.51%) was the most common comorbidity in both cohorts. Complications occurred in 11 (9.48%) patients. More proportion of complication occurred in single chamber group (9 patients, 12.50%) than in dual chamber (2 patients, 4.54%). Complications occurring in dual chamber group include pocket hematoma 1 patient (2.27%) and arrhythmia in 1 patient (2.27%). Similarly, complications occurring in single chamber include RV perforation in two patients (2.77%) and one each (1.38%) had pocket hematoma, pneumothorax, infection, swelling at pocket site, arrhythmia in the form of NSVT, leads displacement, DVT and mortality.
Women were more likely to receive single chamber systems than men. More proportion of complication occurred in single chamber group than in dual chamber. Future prospective studies on larger number of patients are needed to confirm and support our findings.
永久性起搏器植入术是治疗心脏疾病患者的一种微创手术。然而，植入过程中和植入后的并发症并不罕见。在尼泊尔，关于起搏器选择与并发症发生率方面缺乏证据。因此，本研究旨在比较单腔和双腔起搏器的植入频率及并发症发生率。
本研究基于2014年4月至2015年5月在单一中心进行的所有连续性起搏器植入病例。根据植入的起搏器类型，将116例患者分为两个队列——单腔或双腔。所有患者在植入后每2周进行定期随访，并对所有相关患者数据进行标准化记录，直至植入后6周。连续变量数据以均值±标准差（SD）表示，分类变量以比例表示。组间连续变量的比较采用独立样本t检验。对于离散变量，组间分布采用卡方检验进行比较。
植入时总体人群的平均年龄（±SD）为64.08（±15.09）岁。44例（37.93%）患者植入双腔起搏器，72例（62.06%）植入单腔起搏器。只有14名女性（31.81%）接受双腔起搏器，而接受单腔起搏器的女性有42名（58.33%）（卡方=18，自由度=1，P = 0.0084）。完全性房室传导阻滞是永久性起搏器植入最常见的适应证（56.03%），其次是病态窦房结综合征（33.62%）、有症状的高度房室传导阻滞（11.20%）。高血压是两个队列中最常见的合并症（双腔组21.55%，单腔组40.51%）。11例（9.48%）患者发生并发症。单腔组并发症发生率（9例，12.50%）高于双腔组（2例，4.54%）。双腔组发生的并发症包括1例（2.27%）囊袋血肿和1例（2.27%）心律失常。同样，单腔组发生的并发症包括2例（2.77%）右室穿孔，以及各有1例（1.38%）发生囊袋血肿、气胸、感染、囊袋部位肿胀、非持续性室性心动过速形式的心律失常、导线移位、深静脉血栓形成和死亡。
女性比男性更有可能接受单腔系统。单腔组并发症发生率高于双腔组。需要对更多患者进行未来前瞻性研究以证实和支持我们的发现。
