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目的探讨应用主动电极行右室流出道(RVOT)室间隔起搏在临床上的可行性和安全性。方法选择需要安置体内埋藏式心脏起搏器的100例患者,男53例,女47例,年龄39-92岁,平均为(72±13)岁。随机分为两组,50例采用主动固定电极行RVOT室间隔起搏术(主动电极组),50例采用被动固定电极行右室心尖部起搏术(被动电极组),记录两组在术中及术后的各项参数并进行比较。结果两组均顺利完成手术,未出现严重并发症。主动电极组导线的固定次数、曝光时间分别(1．7±1．3)次、(7．9±5．2) min,被动电极组分别为(1．3±0．5)次、(5．4±4．4)min,两组间差异均无统计学意义(P值均>0．05)。主动电极置入后即刻达到理想起搏阈值(0．3-10．0 V),平均为(0．596±0．271)V,但比被动电极组高0．143 v;主动电极组导线阻抗比被动电极组小243Ω(P<0．05),两组感知阈值的差异无统计学意义(P>0．05)。置入后1个月,各项参数均在正常范围,与起搏器植入即刻起搏参数的差异无统计学意义(P值均>0．05)。主动电极组中1例在术后1个月时起搏阈值升高至5 V,两组的起搏阈值的差异无统计学意义(P>0．05)。主动电极组2例、被动电极组1例出现导线脱位。结论应用主动电极行RVOT室间隔部起搏,不增加手术时间和难度、术中及术后并发症发生率。主动固定电极行RVOT室间隔起搏在临床上是安全、可行,值得进一步推广。
Objective To investigate the clinical feasibility and safety of RVOT ventricular septal pacing with active electrode. Methods One hundred patients with implanted pacemakers in the body were selected. There were 53 males and 47 females, aged 39-92 years, with an average of (72 ± 13) years. Fifty patients underwent RVOT ventricular septal pacing (active electrode group) and 50 patients underwent right ventricular apical pacing (passive electrode group) using passive fixed electrode. Fifty patients underwent surgery In and after the various parameters and compare. Results The two groups were successfully completed surgery, no serious complications. The number of fixation and exposure time of active electrode lead were (1.7 ± 1.3) times and (7.9 ± 5.2) minutes, respectively, and that of passive electrode group was (1.3 ± 0.5) times and ( 5.4 ± 4.4) min, there was no significant difference between the two groups (P> 0.05). The active electrode immediately after implantation reached the ideal pacing threshold (0.3-10.0 V) with an average of (0.596 ± 0.271) V, but 0.143 V higher than the passive electrode group. The active electrode group lead Impedance was smaller than that of the passive electrode group by 243Ω (P <0.05). There was no significant difference between the two groups (P> 0.05). One month after implantation, all the parameters were within the normal range, and there was no significant difference between them (P> 0.05) and pacemaker implantation immediate pacing parameters. In the active electrode group, the pacing threshold increased to 5 V at 1 month after operation. There was no significant difference in pacing threshold between the two groups (P> 0.05). Active electrode group 2 cases, passive electrode group 1 cases of wire dislocation. Conclusion The active electrode RVOT ventricular septal pacing, without increasing the operation time and difficulty, intraoperative and postoperative complications. Active fixed electrode RVOT ventricular septal pacing is clinically safe and feasible, it is worth further promotion.