Department of Electrocardiology, John Paul II Hospital, Krakow, Poland Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland.
Kardiol Pol. 2018;76(8):1224-1231. doi: 10.5603/KP.a2018.0089. Epub 2018 Apr 10.
Pacing leads remain the weakest link in pacemaker systems despite advances in manufacturing technology.
The aim of the study was to assess the long-term pacing lead performance in an unselected real-life cohort following primary DDD pacing system implantation.
A single-centre retrospective analysis of patients who underwent DDD pacing system implantation between October 1984 and December 2014 and were followed-up until August 2016 was conducted. The inclusion criterion was at least one follow-up visit after post-implant discharge. The performance of each atrial and ventricular lead implanted was evaluated during the follow-up period, and the incidence of, and predictive factors for, lead dislodgement and failure were analysed.
The data of 3771 patients and 24,431.8 patient-years of follow-up were analysed. The mean follow-up of patients was 77.7 ± 61.8 months. During the study period, 7887 transvenous atrial and right ventricular pacing leads were implanted. Lead dislodgement occurred in 94 (1.2%) leads (92 [2.4%] patients), perforation in 11 (0.1%) leads (10 [0.3%] patients), and lead failure in 329 (4.2%) leads (275 [7.3%] patients). Atrial lead position was a predictive factor for lead dislodgement, while age at implantation, polyurethane 80A insulation, subclavian vein access, unipolar lead construction, and lead manufacturer were multivariate predictors of lead failure.
Leads with polyurethane 80A insulation, unipolar construction, and those implanted via subclavian vein puncture exhibited the worst long-term performance.
尽管制造技术不断进步，但起搏导线仍然是起搏器系统中最薄弱的环节。
本研究旨在评估在未选择的真实生活人群中，在初次植入双腔（DDD）起搏器系统后，起搏导线的长期性能。
对 1984 年 10 月至 2014 年 12 月间接受 DDD 起搏器系统植入且在 2016 年 8 月前完成随访的患者进行单中心回顾性分析。入选标准为植入后至少有一次随访。在随访期间评估每个心房和心室导线的性能，并分析导线脱位和故障的发生率和预测因素。
共分析了 3771 例患者和 24431.8 患者年的随访资料。患者的平均随访时间为 77.7±61.8 个月。研究期间共植入了 7887 根经静脉心房和右心室起搏导线。94 根（1.2%）导线（92 例患者，2.4%）发生了导线脱位，11 根（0.1%）导线（10 例患者，0.3%）发生了穿孔，329 根（4.2%）导线（275 例患者，7.3%）发生了导线故障。导线位置是导线脱位的预测因素，而植入时的年龄、80A 型聚亚安酯绝缘、锁骨下静脉入路、单极导线结构和导线制造商是导线故障的多变量预测因素。
80A 型聚亚安酯绝缘、单极结构和经锁骨下静脉穿刺植入的导线表现出最差的长期性能。
