Ohta Yoshihiro, Goda Akiko, Daimon Aika, Manabe Eri, Masai Kumiko, Kishima Hideyuki, Mine Takanao, Asakura Masanori, Ishihara Masaharu
Department of Cardiovascular and Renal Medicine, School of Medicine, Hyogo Medical University, 1-1 Mukogawacho, Nishinomiya, 663-8501, Japan.
J Med Ultrason (2001). 2023 Jan;50(1):51-56. doi: 10.1007/s10396-022-01274-8. Epub 2022 Dec 15.
Trans-venous pacemaker leads are associated with worsening of tricuspid regurgitation (TR) after pacemaker implantation (PMI) in some cases. Recently, leadless pacemakers and thin ventricular pacemaker leads without a stylet lumen have become popular. However, the differences in the effects of these leads on TR are unclear. We investigated differences in the changes in TR in the early phase after PMI in patients with conventional leads, thin leads, and leadless pacemakers.
We enrolled 65 patients who underwent PMI (32 males, 79 ± 8 years), including 48 with trans-venous PMI (29 with conventional 6.0-Fr leads and 19 with 4.1-Fr thin leads) and 17 with leadless pacemakers. Transthoracic echocardiography was performed before and 1 month after PMI for assessment of conventional echocardiographic parameters and severity of TR by quantitative assessment.
Atrial fibrillation was the most frequent indication for PMI in patients with leadless pacemakers (p = 0.015). In the before and 1 month after PMI comparison, left ventricular ejection fraction decreased after PMI only in the conventional lead group (p = 0.022). The TR effective regurgitant orifice area (EROA) decreased post PMI in the leadless (p = 0.002) and thin lead groups (p = 0.001), but not in the conventional lead group (p = 0.596). The change in TR EROA was greater in the leadless and thin lead groups as compared with the conventional lead group (p < 0.05).
The decrease in TR EROA in the early phase after PMI differed according to the type of pacemaker lead. The thin lead might be beneficial for reduction of TR after PMI.
在某些情况下，经静脉起搏器导线与起搏器植入（PMI）后三尖瓣反流（TR）的恶化有关。近来，无导线起搏器和没有管心针腔的细心室起搏器导线已变得流行。然而，这些导线对TR的影响差异尚不清楚。我们研究了使用传统导线、细导线和无导线起搏器的患者在PMI后早期TR变化的差异。
我们纳入了65例行PMI的患者（32例男性，79±8岁），其中48例行经静脉PMI（29例使用传统6.0F导线，19例使用4.1F细导线），17例使用无导线起搏器。在PMI前和PMI后1个月进行经胸超声心动图检查，以通过定量评估来评估传统超声心动图参数和TR的严重程度。
无导线起搏器患者中，心房颤动是PMI最常见的适应证（p = 0.015）。在PMI前和PMI后1个月的比较中，仅传统导线组在PMI后左心室射血分数降低（p = 0.022）。无导线组（p = 0.002）和细导线组（p = 0.001）在PMI后TR有效反流口面积（EROA）减小，而传统导线组未减小（p = 0.596）。与传统导线组相比，无导线组和细导线组TR EROA的变化更大（p < 0.05）。
PMI后早期TR EROA的降低因起搏器导线类型而异。细导线可能有利于减少PMI后的TR。
