Cardiac Pacing and Electrophysiology Department, The First Affiliated Hospital of Xinjiang Medical University, No.137, South Liyushan Road, Xinshi Zone, Urumqi, Xinjiang, China.
Xinjiang Key Laboratory of Cardiac Electrophysiology and Cardiac Remodeling, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.
J Interv Card Electrophysiol. 2023 Jun;66(4):941-949. doi: 10.1007/s10840-022-01399-3. Epub 2022 Oct 25.
Implanting leadless pacemakers in the right ventricular (RV) apex is prone to causing pericardial tamponade and myocardial perforation.
To investigate the feasibility and safety of right ventriculography-guided implantation of Micra™ leadless pacemaker (Micra™, Medtronic, Minneapolis, MN, USA) in the RV mid-septum.
One hundred eight consecutive patients who underwent Micra™ implantation intended in the mid-septum were enrolled and randomized (3:1) into the radiography group (n = 81) with assistance of right ventriculography to illustrate the RV septum and the non-radiography group (n = 27). All subjects underwent a postoperative computed tomography (CT) scan to determine the Micra™ location. The Micra™ location assessed by CT image was compared between the two groups to confirm the accuracy of the intended pacing site. The duration of the procedure, X-ray radiation dose, and time were also compared between the two groups.
Reconstructed CT 3-D cardiac images found the Micra™ location in the intended mid-septum in 13 patients (48.1%, 13/27) in the non-radiography group and 76 patients (93.8%, 76/81) in the radiography group (P < 0.0001 between two groups). There was no significant difference in procedure interval between the two groups while the X-ray radiation dose (564.86 ± 112.44 vs. 825.85 ± 156.12 mGy, P < 0.0001), X-ray exposure time (7.79 ± 1.43 vs. 12.03 ± 2.86 min, P < 0.0001), and the number of fluoroscopy re-positioning (2.79 ± 1.03 vs. 6.41 ± 1.82, P < 0.0001) were significantly less in the radiography group than in the non-radiography group. No implantation-related complications were observed in both groups.
Right ventriculography increases the accuracy of Micra™ implantation in the mid-septum and reduces X-ray exposure.
The trial registration number (ChiCTR2100051374) and date (09/22/2021).
在右心室（RV）心尖植入无导线起搏器容易导致心包填塞和心肌穿孔。
探讨在右心室中隔行右心室造影引导植入 Micra™无导线起搏器（Micra™，美敦力，明尼苏达州明尼阿波利斯）的可行性和安全性。
连续纳入 108 例拟在中隔植入 Micra™的患者，随机（3：1）分为造影组（n = 81）和非造影组（n = 27），造影组通过右心室造影显示 RV 中隔和非造影组。所有患者术后均行 CT 扫描确定 Micra™位置。比较两组 CT 图像评估的 Micra™位置，以确认目标起搏部位的准确性。比较两组手术时间、X 线辐射剂量和时间。
非造影组 27 例患者中有 13 例（48.1%，13/27）在右心室造影组中重建 CT 三维心脏图像发现 Micra™位于预期的中隔，81 例患者（93.8%，76/81）在右心室造影组（两组间 P < 0.0001）。两组手术间隔无显著性差异，而 X 线辐射剂量（564.86 ± 112.44 比 825.85 ± 156.12 mGy，P < 0.0001）、X 线曝光时间（7.79 ± 1.43 比 12.03 ± 2.86 min，P < 0.0001）和透视重定位次数（2.79 ± 1.03 比 6.41 ± 1.82，P < 0.0001）明显少于非造影组。两组均未见与植入相关的并发症。
右心室造影可提高 Micra™在中隔植入的准确性，并减少 X 线暴露。
试验注册号（ChiCTR2100051374）和日期（09/22/2021）。
