Cardiology Division, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong SAR, China; Division of Cardiology, Department of Medicine, University of Hong Kong Shenzhen Hospital, Hong Kong SAR, China.
Cardiology Division, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong SAR, China.
Heart Rhythm. 2019 Jun;16(6):896-902. doi: 10.1016/j.hrthm.2018.12.007. Epub 2018 Dec 11.
The major risk of implanting a leadless pacemaker at the right ventricular (RV) apex is cardiac perforation.
The purpose of this study was to describe and prospectively evaluate the safety and feasibility of a technique for midseptal implantation of the Micra leadless pacemaker.
We positioned the device at the center of the cardiac silhouette in the right anterior oblique (RAO) view, toward the left in the left anterior oblique (LAO) view, and away from the sternum in the left lateral view.
Among the 51 patients (mean age 81.3 ± 9.3 years; 47% men) included in the study, 29 (57%) were >80 years old, 7 (14%) had body mass index <20 kg/m, 48 (94%) had renal dysfunction, and 33 (65%) had valvular heart disease. The implantation sites were mid and apical septum in 46 (90%) and 5 (10%) patients, respectively. Although RAO and LAO views suggested a septal location, 9 (17.6%) devices were found to be directing at the free wall in the left lateral view and required repositioning. One patient (2%) developed cardiac perforation due to contrast injection against the RV anterior wall before verification of sheath location by lateral view. Mean R-wave sensing and pacing threshold at implantation were 9.7 ± 4.0 mV and 0.61 ± 0.31 V/0.24 ms, respectively. After median follow-up of 218.7 days, the pacing threshold remained stable.
In this high-risk patient cohort, midseptal implantation of a leadless pacemaker as guided by RAO, LAO, and left lateral views was achieved in 90% of patients, with a low risk of complications.
在右心室（RV）心尖植入无导线起搏器的主要风险是心脏穿孔。
本研究旨在描述并前瞻性评估一种在中隔植入 Micra 无导线起搏器的技术的安全性和可行性。
我们在右前斜位（RAO）视图中将设备置于心脏轮廓的中心，在左前斜位（LAO）视图中向左侧，在左侧位视图中远离胸骨。
在纳入的 51 名患者（平均年龄 81.3±9.3 岁；47%为男性）中，29 名（57%）年龄>80 岁，7 名（14%）体重指数<20kg/m，48 名（94%）存在肾功能不全，33 名（65%）患有心脏瓣膜病。植入部位分别为中隔和心尖间隔 46 例（90%）和 5 例（10%）。尽管 RAO 和 LAO 视图提示间隔位置，但在左侧位视图中发现 9 例（17.6%）设备指向游离壁，需要重新定位。1 例（2%）患者因在通过左侧视图验证鞘位置之前向 RV 前壁注射造影剂而发生心脏穿孔。植入时的平均 R 波感知和起搏阈值分别为 9.7±4.0mV 和 0.61±0.31V/0.24ms。中位随访 218.7 天后，起搏阈值保持稳定。
在这一高危患者队列中，通过 RAO、LAO 和左侧位视图引导的无导线起搏器中隔植入在 90%的患者中得以实现，并发症风险较低。
