Kazama S, Nishiyama K, Machii M, Tanaka K, Amano T, Nomura T, Ohuchi M, Kasahara S, Nie M, Ishihara A
Department of Thoracic Surgery, Kitasato University School of Medicine, Kanagawa, Japan.
Jpn Heart J. 1993 Mar;34(2):193-200. doi: 10.1536/ihj.34.193.
Five hundred and sixty-one endocardial pacing leads implanted in the right ventricle of 502 patients between 1971 and 1990 were followed for up to 17 years regarding their complications, stimulation threshold behavior, and overall longevity. Lead tip dislodgment occurred in 16 leads (2.9%), in 14 of which dislodgement occurred within 2 months after implantation. The incidence of dislodgement was significantly smaller in tined leads than in nontined leads. Lead conductor fracture occurred in 19 leads (3.4%), in 15 of which fracture occurred within 5 years after implantation. Two particular sites of lead fracture were identified; i.e., one within the pacemaker pocket and the other at a particular point in the subclavian vein between the clavicle and the first rib. Fixation ligature in the former site and the venopuncture point for lead insertion in the latter site are thought to be related to lead fracture. Other complications included insulator break in 3 leads (0.5%), exit block in 7 leads (1.2%), and poor sensing in 2 leads (0.4%). The cumulative survival of leads was 94.1 +/- 2.7% (mean +/- 95% confidence interval) at 5 years, 86.3 +/- 6.3% at 10 years, and 74.2 +/- 14.0% at 15 years after implantation. The minimal stimulation threshold, lead impedance and R wave amplitude were all found to be stable for up to 10 years, and there were no tendencies toward higher stimulation threshold during the observation period of this study.
1971年至1990年间，对502例患者右心室植入的561根心内膜起搏导线进行了长达17年的随访，观察其并发症、刺激阈值变化及整体使用寿命。16根导线（2.9%）发生导线尖端脱位，其中14根在植入后2个月内发生脱位。有倒刺导线的脱位发生率明显低于无倒刺导线。19根导线（3.4%）发生导线导体断裂，其中15根在植入后5年内发生断裂。确定了两个导线断裂的特定部位，即一个在起搏器囊袋内，另一个在锁骨与第一肋骨之间锁骨下静脉的特定点。认为前者部位的固定结扎和后者部位导线插入的静脉穿刺点与导线断裂有关。其他并发症包括3根导线（0.5%）发生绝缘体破裂、7根导线（1.2%）发生出口阻滞和2根导线（0.4%）发生感知不良。植入后5年导线的累积生存率为94.1±2.7%（平均值±95%置信区间），10年时为86.3±6.3%，15年时为74.2±14.0%。最小刺激阈值、导线阻抗和R波振幅在长达10年的时间内均保持稳定，在本研究的观察期内未出现刺激阈值升高的趋势。
