Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhong Shan Hospital of Fudan University, Shanghai, China.
Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhong Shan Hospital of Fudan University, Shanghai, China.
Int J Cardiol. 2018 May 1;258:121-125. doi: 10.1016/j.ijcard.2018.01.005. Epub 2018 Feb 8.
Presence of adequate current of injury (COI) was recognized as a sign of favorable pacemaker lead outcome. Little is known regarding the value of its dynamic behavior. We sought to test whether persistency of COI could predict active-fixation pacing lead performance.
COI was monitored up to 10min after right ventricular (RV) pacing electrode fixation. COI persistency was defined as the percentage of COI magnitude relative to its initial measurement. An unacceptable pacing threshold (≥1.0V in acute evaluation or ≥2.0V over 2-year follow-up) with or without lead dislodgement was considered as lead failure.
Lead implantation was attempted for 217 times in 174 patients (age 66.3±7.8years, 78 female). Acute lead failures occurred 43 times. Independent predictors of acute lead failure were RV enlargement (odds ratio [OR] 1.23, 95% confidential interval [CI] 1.11-2.04, P=0.033), absence of COI (OR 3.13, 95%CI 2.08-9.09, P=0.027), and COI persistency at 5min (OR 0.32, 95%CI 0.20-0.69, P=0.001) and 10min (OR 0.41, 95%CI 0.13-0.77, P=0.001). The optimal cutoffs were COI persistency ≥50% (sensitivity 81.4%; specificity 81.9%) and COI persistency ≥20% (sensitivity 86%; specificity 88.6%). There were 12 lead failures during 24.0±6.4months of follow-up. Patients with COI persistency ≥50% had higher event-free survival compared to those with COI persistency <50% (hazard ratio 3.54, 95% CI 1.04-12.06, P=0.043).
COI persistency appears to be a valuable indicator for both acute and long-term outcome of active-fixation pacemaker leads. A precipitous decline in COI may require more attention to make sure of the lead performance.
已有研究表明，充分的电流损伤（COI）存在是有利的起搏器导联的结果。但对于其动态行为的价值知之甚少。我们试图测试 COI 的持续性是否可以预测主动固定起搏导联的性能。
在右心室（RV）起搏电极固定后，监测 COI 长达 10 分钟。COI 持续性定义为 COI 幅度与其初始测量值的百分比。急性评估中起搏阈值≥1.0V 或 2 年随访中起搏阈值≥2.0V 伴或不伴有导联脱位被认为是导联故障。
174 例患者共进行了 217 次导联植入（年龄 66.3±7.8 岁，女性 78 例）。发生急性导联故障 43 次。RV 扩大（优势比[OR] 1.23，95%置信区间[CI] 1.11-2.04，P=0.033）、无 COI（OR 3.13，95%CI 2.08-9.09，P=0.027）和 COI 在 5min（OR 0.32，95%CI 0.20-0.69，P=0.001）和 10min（OR 0.41，95%CI 0.13-0.77，P=0.001）时的持续性是急性导联故障的独立预测因素。最佳截断值为 COI 持续性≥50%（敏感性 81.4%；特异性 81.9%）和 COI 持续性≥20%（敏感性 86%；特异性 88.6%）。在 24.0±6.4 个月的随访中，有 12 例发生导联故障。COI 持续性≥50%的患者与 COI 持续性<50%的患者相比，无事件生存率更高（风险比 3.54，95%置信区间 1.04-12.06，P=0.043）。
COI 持续性似乎是主动固定起搏器导联急性和长期结果的一个有价值的指标。COI 急剧下降可能需要更多关注，以确保导联性能。
