Arrhythmia, Electrophysiology, Pacemaker Research and Management Center, Department of Cardiology, Kocaeli University Medical Faculty, Umuttepe Yerleskesi, Kocaeli, Turkey.
Department of Cardiovascular Surgery, Kocaeli University Medical Faculty, Kocaeli, Turkey.
J Cardiovasc Electrophysiol. 2024 Mar;35(3):399-405. doi: 10.1111/jce.16181. Epub 2024 Jan 8.
Active-fixation leads have been associated with higher incidence of cardiac perforation. Large series specifically evaluating radiographic predictors of right ventricular (RV) lead perforation are lacking.
We conducted a retrospective observational study including 1691 consecutive patients implanted with an active fixation pacing and defibrillator lead at our institution between January 2015 and January 2021. Fourteen patients who had clinically relevant RV perforation caused by pacemaker and implantable cardioverter-defibrillator leads were included in the study.
Univariate and multivariate analyses were used to identify predictors of RV perforation. In multivariate analysis, lead slack score (odds ratio [OR]: 3.694, 95% confidence interval [CI]: 1.066-12.807; p = .039), change in lead slack height (OR: 1.218, 95% CI: 1.011-1.467; p = .038) and width (OR: 1.253, 95% CI: 1.120-1.402; p = .001), left ventricular ejection fraction (OR: 0.995, 95% CI: 0.910-1.088; p = .032) were independent predictors of RV perforation.
Fluoroscopic predictors of RV perforation associated with RV lead can be easily determined during implantation. Identification of these predictors may prevent the sequelae of RV perforation associated with active-fixation leads.
主动固定导联与更高的心脏穿孔发生率有关。目前缺乏专门评估右心室（RV）导联穿孔放射学预测因素的大型系列研究。
我们进行了一项回顾性观察性研究，纳入了 2015 年 1 月至 2021 年 1 月期间在我院植入主动固定起搏和除颤器导联的 1691 例连续患者。本研究纳入了 14 例因起搏器和植入式心脏复律除颤器导联导致临床相关 RV 穿孔的患者。
采用单变量和多变量分析来确定 RV 穿孔的预测因素。在多变量分析中，导丝松弛评分（比值比 [OR]：3.694，95%置信区间 [CI]：1.066-12.807；p=0.039）、导丝松弛高度变化（OR：1.218，95%CI：1.011-1.467；p=0.038）和宽度变化（OR：1.253，95%CI：1.120-1.402；p=0.001）、左心室射血分数（OR：0.995，95%CI：0.910-1.088；p=0.032）是 RV 穿孔的独立预测因素。
在植入过程中可以轻松确定与 RV 导联相关的 RV 穿孔的透视预测因素。识别这些预测因素可能有助于防止与主动固定导联相关的 RV 穿孔的后遗症。
