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目的:评估无导线起搏器（LTP）植入术中牵拉试验导致阈值变化及其对术后短期阈值变化的预测价值。方法:入选2018年11月至2020年11月复旦大学附属中山医院植入LTP（Micra，美国美敦力公司）并完成1个月随访的患者，收集其释放后即刻、牵拉试验后即刻、5 min、10 min、出院时和术后1个月的阈值，比较牵拉前后阈值的变化。按术后1个月的阈值变化将患者分为阈值升高组与阈值稳定组，评估牵拉后阈值变化对术后1个月阈值变化的预测价值。结果:共入选患者35例，全部患者出院时阈值较释放后阈值显著下降[（0.48±0.10）V对（0.70±0.37）V，n P=0.03]。其中阈值升高组（n n=13）术后1个月阈值较出院时显著升高[（0.58±0.11）V对（0.52±0.13）V，n P=0.03]，牵拉后即刻阈值较释放后显著升高[（0.71±0.25）V对（0.57±0.18）V，n P=0.01]；阈值稳定组（n n=22）出院时、术后1个月阈值均较释放后显著降低[（0.45±0.09）V对（0.78±0.44）V，n P=0.03；（0.42±0.06）V对（0.78±0.44）V，n P=0.03]。单因素和Logistic多因素回归分析显示牵拉后即刻较释放后即刻阈值升高是术后短期阈值升高的独立预测因素（n OR=1.25，n P=0.03；n OR=1.78，n P=0.04）。n 结论:LTP植入术中牵拉试验导致阈值有下降趋势。牵拉后即刻阈值升高是LTP术后短期阈值升高的独立预测因素。“,”Objective:To investigate the threshold change of leadless pacemaker (LTP) after pull and hold test, and its predictive value for short-term change in threshold.Methods:Patients undergoing LTP implantation in Zhongshan Hospital from November 2018 to November 2020 were included. Threshold parameters after deployment, instantly, 5 min, 10 min after pull and hold test, before discharge, and 1 month after implantation were collected and compared. Patients were divided into elevated threshold group and stable threshold group. The predicted value for threshold change after pull and hold test were evaluated.Results:A total of 35 patients were included for analysis. All patients had a lower threshold before discharge compared with that after deployment [ (0.48±0.10) V vs. (0.70±0.37) V, n P=0.03] . In the elevated threshold group (n n=13) , the threshold increased instantly after pull and hold test [ (0.71±0.25) V vs. (0.57±0.18) V, n P=0.01] , and increased 1 month after implantation over discharge [ (0.58±0.11) V vs. (0.52±0.13) V, n P=0.03] . In the stable threshold group (n n=22) , the threshold decreased at both discharge and 1 month after implantation over deployment [ (0.45±0.09) V vs. (0.78±0.44) V, n P=0.03; (0.42±0.06) V vs. (0.78±0.44) V, n P=0.03] , respectively. Univariable and multivariable Logistic analysis showed that an elevated threshold after pull and hold test was an independent predictor of threshold elevation at short-term follow-up after Micra implantation (n OR=1.25, n P=0.03; n OR=1.78, n P=0.04) .n Conclusion:There was a trend for decrease of threshold after pull and hold test. An elevated threshold after pull and hold test was an independent predictor of threshold elevation at short-term follow-up after LTP implantation.