Witt Chance M, Lenz Charles J, Shih Henry H, Ebrille Elisa, Rosenbaum Andrew N, van Zyl Martin, Aung Htin, Manocha Kevin K, Deshmukh Abhishek J, Hodge David O, Mulpuru Siva K, Cha Yong-Mei, Espinosa Raul E, Asirvatham Samuel J, Mcleod Christopher J
Department of Cardiovascular Diseases.
Department of Medicine.
J Cardiovasc Electrophysiol. 2017 Aug;28(8):924-930. doi: 10.1111/jce.13256. Epub 2017 Jun 21.
Cardiac pacing from the right ventricular apex is associated with detrimental long-term effects and nonapical pacing locations may be associated with improved outcomes. There is little data regarding complications with nonapical lead positions. The aim of this study was to assess long-term outcomes and lead-related complications associated with differing ventricular lead tip position.
All adult patients who underwent dual-chamber pacemaker implantation from 2004 to 2014 were included if they had postprocedure chest radiographs amenable to lead position determination. Long-term outcomes and lead-related complication rates were recorded. These were compared at 5 years between: (1) apical and septal leads, (2) apical and nonseptal nonapical (NSNA), and (3) apical and septal with >40% ventricular pacing. We retrospectively evaluated 3,450 patients, which included 238 with a septal position and 733 with NSNA lead positions. Septal lead position was associated with a lower mortality compared to apical leads (24% vs. 31%, P = 0.02). In patients with greater than 40% pacing, septal leads were associated with significantly higher rates of incident atrial fibrillation compared to apical leads (49% vs. 34%, P = 0.04). NSNA positions were associated with a significantly higher rate of lead dislodgement (4% vs. 2%, P = 0.005) and need for revision (8% vs. 5%, P = 0.005).
Septal pacemaker lead position is associated with a lower mortality compared to apically placed leads, but a higher incidence of atrial fibrillation with higher percentage ventricular pacing. NSNA lead locations are associated with more complications and should be avoided.
右心室心尖部起搏与不良的长期影响相关，而非心尖部起搏位置可能与更好的预后相关。关于非心尖部电极位置的并发症的数据很少。本研究的目的是评估与不同心室电极尖端位置相关的长期预后和电极相关并发症。
纳入2004年至2014年接受双腔起搏器植入的所有成年患者，条件是术后胸部X线片适合确定电极位置。记录长期预后和电极相关并发症发生率。在5年时对以下情况进行比较：（1）心尖部与间隔部电极；（2）心尖部与非间隔部非心尖部（NSNA）电极；（3）心尖部与心室起搏比例>40%的间隔部电极。我们回顾性评估了3450例患者，其中包括238例间隔部位置患者和733例NSNA电极位置患者。与心尖部电极相比，间隔部电极位置与较低的死亡率相关（24%对31%，P = 0.02）。在起搏比例大于40%的患者中，与心尖部电极相比，间隔部电极与心房颤动的发生率显著更高相关（49%对34%，P = 0.04）。NSNA位置与电极脱位的发生率显著更高相关（4%对2%，P = 0.005）以及需要进行修正的比例更高（8%对5%，P = 0.005）。
与心尖部放置的电极相比，间隔部起搏器电极位置与较低的死亡率相关，但在心室起搏比例较高时心房颤动的发生率更高。NSNA电极位置与更多并发症相关，应避免使用。
