Harvey J R, Wyman R M, McKay R G, Baim D S
Charles A. Dana Research Institute, Boston, Massachusetts.
Am J Cardiol. 1988 Nov 1;62(13):941-4. doi: 10.1016/0002-9149(88)90897-1.
The use of prophylactic temporary pacemakers during diagnostic catheterization, coronary angioplasty and percutaneous balloon valvuloplasty was investigated retrospectively over an 18-month period. Balloon flotation temporary pacemaker leads were placed in 193 (12%) of 1,609 patients undergoing diagnostic catheterization, 641 (65%) of 993 patients undergoing coronary angioplasty and 199 (100%) of 199 patients undergoing aortic or mitral valvuloplasty. There were no perforations or significant arrhythmic complications related to pacemaker placement in these 1,033 cases, and pacing was initiated promptly when required by withdrawal of the catheter tip into the right ventricle. Significant bradycardia or new conduction defects developed in 17 patients (1%) during diagnostic catheterization, 10 patients (1%) during angioplasty and 20 patients (10%) during valvuloplasty, but were severe enough to require initiation of temporary pacing in only 1 (0.06%), 4 (0.4%) and 5 (2.5%) patients, respectively. No patient undergoing diagnostic catheterization or angioplasty (but 5 patients undergoing valvuloplasty) required immediate pacing support to treat a life-threatening bradycardia. The total cost of prophylactic pacemakers was $103,300, with a cost per actual use of $19,300 for diagnostic cases, $16,025 for angioplasty and $3,980 for balloon valvuloplasty. These data suggest that prophylactic temporary pacing is not indicated during either diagnostic catheterization or coronary angioplasty, but should be used routinely during balloon valvuloplasty.
我们回顾性研究了18个月期间在诊断性心导管插入术、冠状动脉成形术和经皮球囊瓣膜成形术中预防性使用临时起搏器的情况。在1609例接受诊断性心导管插入术的患者中，有193例（12%）放置了球囊漂浮临时起搏器导线；在993例接受冠状动脉成形术的患者中，有641例（65%）放置了该导线；在199例接受主动脉或二尖瓣瓣膜成形术的患者中，有199例（100%）放置了该导线。在这1033例病例中，没有发生与起搏器放置相关的穿孔或严重心律失常并发症，并且当导管尖端撤回右心室需要起搏时能够迅速启动起搏。在诊断性心导管插入术期间，17例（1%）患者出现显著心动过缓或新的传导缺陷；在冠状动脉成形术期间，10例（1%）患者出现上述情况；在瓣膜成形术期间，20例（10%）患者出现上述情况，但严重到需要启动临时起搏的患者分别只有1例（0.06%）、4例（0.4%）和5例（2.5%）。接受诊断性心导管插入术或冠状动脉成形术的患者中（但有5例接受瓣膜成形术的患者），没有患者需要立即起搏支持来治疗危及生命的心动过缓。预防性起搏器的总费用为103,300美元，诊断病例每次实际使用的费用为19,300美元，冠状动脉成形术为16,025美元，球囊瓣膜成形术为3,980美元。这些数据表明，在诊断性心导管插入术或冠状动脉成形术期间不建议预防性临时起搏，但在球囊瓣膜成形术期间应常规使用。
