Vurgun Veysel Kutay, Baskovski Emir, Goksuluk Huseyin, Ozyuncu Nil, Tan Turkan Seda, Altin Ali Timucin, Candemir Basar, Akyurek Omer
Cardiology Department, Ankara University School of Medicine, Cebeci Kalp Merkezi, Mamak Street, 06100, Mamak, Ankara, Turkey.
J Interv Card Electrophysiol. 2018 Nov;53(2):249-254. doi: 10.1007/s10840-018-0395-2. Epub 2018 Jun 13.
Dermal and myocardial injury results in a healing process, characterized by inflammation and fibrosis. We aimed to investigate association between proliferative scarring at the operation site and right ventricular (RV) pacing and sensing parameters, two clinical outcomes associated with impaired dermal and myocardial healing, respectively.
We performed an observational retrospective study among regularly followed pacemaker (PM)/implantable cardioverter defibrillator (ICD)-implanted patients at our medical center. Patients, who had a first RV active fixation PM/ICD lead implantation procedure and a minimum follow-up of 1 year, were included in the study. Redo procedures, passive fixation RV leads, epicardial leads, generator replacement procedures, and patients using class I and III anti-arrhythmic drugs were excluded. Patients in the control group, matched by age, sex and implanted device and lead type, were randomly selected from the patient pool. Lead impedance, pacing threshold, and R wave measurements obtained at baseline and at 3rd, 6th, and 12th month were analyzed.
Baseline characteristics of study and control groups were similar. While baseline and follow-up lead impedance and R wave measurements along with baseline and 3rd-month pacing thresholds showed no significant difference between two groups, 6th- and 12th-month pacing thresholds revealed statistically significant increase in proliferative scar group compared to control group (0.87 vs 0.72 p = 0.003 and 0.87 vs 0.71 p = 0.003, respectively).
PM/ICD-implanted patients with proliferative scar on pocket wound may show increased RV pacing thresholds compared to patients with normal healing of pocket wound.
皮肤和心肌损伤会引发一个以炎症和纤维化为特征的愈合过程。我们旨在研究手术部位增生性瘢痕与右心室（RV）起搏及感知参数之间的关联，这两个临床结果分别与皮肤和心肌愈合受损相关。
我们在本医疗中心对定期随访的植入起搏器（PM）/植入式心脏复律除颤器（ICD）的患者进行了一项观察性回顾性研究。纳入研究的患者为首次进行RV主动固定PM/ICD导线植入手术且至少随访1年的患者。再次手术、被动固定RV导线、心外膜导线、发生器更换手术以及使用I类和III类抗心律失常药物的患者被排除。对照组患者从患者库中随机选取，根据年龄、性别、植入设备和导线类型进行匹配。分析在基线以及第3、6和12个月时获得的导线阻抗、起搏阈值和R波测量值。
研究组和对照组的基线特征相似。虽然两组之间基线和随访时的导线阻抗及R波测量值以及基线和第3个月的起搏阈值没有显著差异，但与对照组相比，增生性瘢痕组在第6个月和第12个月时的起搏阈值有统计学意义的升高（分别为0.87对0.72，p = 0.003；0.87对0.71，p = 0.003）。
与口袋伤口正常愈合的患者相比，口袋伤口有增生性瘢痕的植入PM/ICD患者可能表现出更高的RV起搏阈值。
