无导线起搏器在超高龄患者中的安全性。
Safety of leadless pacemaker implantation in the very elderly.
机构信息
Division of Electrophysiology, North Shore University Hospital, Northwell Health, Manhasset, New York.
Division of Electrophysiology, North Shore University Hospital, Northwell Health, Manhasset, New York.
出版信息
Heart Rhythm. 2020 Dec;17(12):2023-2028. doi: 10.1016/j.hrthm.2020.05.022. Epub 2020 May 23.
BACKGROUND
The Micra leadless pacemaker (MLP) has proven to be an effective alternative to a traditional transvenous pacemaker (TVP). However, there has been concern about using the MLP in frail elderly patients because of the size of the implant sheath and perceived risk of perforation.
OBJECTIVES
The objectives of this study were to report the safety of the MLP and compare MPLs with TVPs in the very elderly.
METHODS
All patients 85 years and older who received an MLP or a single-chamber TVP across 6 hospitals in the Northwell Health system from December 2015 to November 2019 were included. Demographic characteristics, procedural details, and procedure-related complications were reviewed.
RESULTS
Over 4 years, 564 patients underwent MLP implantation. During this time, 183 MLPs and 119 TVPs were implanted in patients 85 years and older. The mean age was 89.7 ± 3.4 years, and 47.4% were men. MLP implantation was successful in all but 3 patients (98.4% success rate). There was no difference in procedure-related complications (3.3% vs 5.9%; P = .276). Complications included 5 (2.7%) access site hematomas in the MLP group, 3 (2.5%) in the TVP group, 1 (0.5 vs 0.8%) pericardial effusion in each group, and 3 (2.5%) acute lead dislodgments (<24 hours) in the TVP group. MLP implantation resulted in a significantly shorter mean procedure time (35.7 ± 23.0 minutes vs 62.3 ± 31.5 minutes, P < .001).
CONCLUSION
In a large multicenter study of patients 85 years and older, MLP implantation (1) was successful in 98.4% of patients, (2) was safe with no difference in procedure-related complications compared to the TVP group, and (3) resulted in significantly shorter procedure times.
背景
无导线心脏起搏器（MLP）已被证明是传统经静脉起搏器（TVP）的有效替代方案。然而，由于植入鞘的尺寸以及穿孔的风险，人们对在体弱的老年患者中使用 MLP 存在担忧。
目的
本研究旨在报告 MLP 的安全性，并比较 MLP 与 TVP 在非常老年患者中的应用。
方法
纳入了 2015 年 12 月至 2019 年 11 月期间在 Northwell Health 系统的 6 家医院接受 MLP 或单腔 TVP 的所有 85 岁及以上患者。回顾了人口统计学特征、手术细节和与手术相关的并发症。
结果
在 4 年期间，564 例患者接受了 MLP 植入术。在此期间，183 例 MLP 和 119 例 TVP 植入了 85 岁及以上的患者。平均年龄为 89.7 ± 3.4 岁，47.4%为男性。除 3 例患者（98.4%的成功率）外，其余患者的 MLP 植入均成功。与 TVP 组相比，与手术相关的并发症无差异（3.3% vs 5.9%；P =.276）。并发症包括 MLP 组 5 例（2.7%）、TVP 组 3 例（2.5%）的穿刺部位血肿，每组各 1 例（0.5% vs 0.8%）的心包积液，以及 TVP 组 3 例（2.5%）急性导线脱位（<24 小时）。MLP 植入术的平均手术时间明显缩短（35.7 ± 23.0 分钟 vs 62.3 ± 31.5 分钟，P<0.001）。
结论
在一项对 85 岁及以上患者的大型多中心研究中，MLP 植入术（1）在 98.4%的患者中获得成功，（2）与 TVP 组相比，安全性无差异，且（3）手术时间明显缩短。
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