Connelly D T, Steinhaus D M, Handlin L, Lemery R, Moutray K, Foley L, Davie S, Cardinal D, Lipke J
Mid America Heart Institute, Saint Luke's Hospital, Kansas City, Missouri, USA.
Pacing Clin Electrophysiol. 1997 Oct;20(10 Pt 1):2429-33. doi: 10.1111/j.1540-8159.1997.tb06082.x.
The right atrial appendage is often amputated at the time of cardiopulmonary bypass. Because of concerns regarding lead displacement, use of active fixation atrial leads has been recommended in patients who require permanent atrial or dual chamber pacing after open heart surgery. We evaluated the acute and chronic performance of active and passive fixation atrial leads implanted at our institution between 1985 and 1993 in patients with previous open heart surgery. Of 78 consecutive patients, 38 had an active fixation atrial lead, 28 had a passive fixation steroid-eluting lead, and 12 had a passive fixation lead without steroid-eluting properties. At implantation, sensed P wave amplitudes were similar in the three groups, but lead impedance and threshold were significantly higher for active fixation leads compared to all passive fixation leads. During follow-up, atrial pacing thresholds were significantly higher, and sensed P wave amplitudes significantly lower, in the patients with active fixation leads compared to those with passive fixation leads. Loss of sensing occurred in 6 of 38 (16%) patients with active fixation leads and 1 of 40 (2.5%) patients with a passive fixation lead (P = 0.027). Atrial lead displacement occurred in two patients with active fixation leads and one with a passive fixation lead. Comparison with a parallel group of patients without previous open heart surgery demonstrated that atrial lead performance was similar in the two groups. We conclude that, when permanent atrial or dual chamber pacing is necessary in patients with prior open heart surgery, it is appropriate to implant a passive fixation atrial lead except on the infrequent occasions when a stable atrial position cannot be obtained.
右心耳常在体外循环时被切除。由于担心导线移位，对于心脏直视手术后需要永久性心房或双腔起搏的患者，推荐使用主动固定心房导线。我们评估了1985年至1993年间在我院植入的主动和被动固定心房导线在曾接受心脏直视手术患者中的急性和慢性性能。在78例连续患者中，38例植入了主动固定心房导线，28例植入了被动固定类固醇洗脱导线，12例植入了无类固醇洗脱特性的被动固定导线。植入时，三组的P波感知振幅相似，但主动固定导线的导线阻抗和阈值显著高于所有被动固定导线。随访期间，与被动固定导线的患者相比，主动固定导线的患者心房起搏阈值显著更高，P波感知振幅显著更低。38例植入主动固定导线的患者中有6例（16%）发生感知丧失，40例植入被动固定导线的患者中有1例（2.5%）发生感知丧失（P = 0.027）。2例植入主动固定导线的患者和1例植入被动固定导线的患者发生了心房导线移位。与一组无既往心脏直视手术的平行患者比较表明，两组的心房导线性能相似。我们得出结论，对于曾接受心脏直视手术且需要永久性心房或双腔起搏的患者，除了在很少无法获得稳定心房位置的情况下，植入被动固定心房导线是合适的。
