CAJ | 학술논문

目的：探讨改良主动固定起搏电极导线塑型行右室流出道间隔部起搏的可行性与安全性。方法136例需要植入人工心脏起搏器，且需要植入心室主动固定起搏电极导线的患者，随机分为两组，传统电极塑型组（CRVOTP）将电极导线内芯钢丝塑型为双弯三维形状进行右室流出道间隔部电极固定；改良电极塑型组（MRVOTP）将电极导线内芯钢丝塑型为J弯进行右室流出道间隔部电极固定。结果两组均100%成功行右室流出道间隔部起搏，无严重并发症，术中电极固定次数、起搏阈值、阻抗、R波高度及QRS波宽度比较，两组间均无显著统计学差异。由于MRVOTP组塑型简单，容易通过三尖瓣环及直接到达右室流出道间隔部，X线曝光、植入时间较CRVOTP组明显缩短，有显著统计学意义（P<0.05），并较少损伤起搏电极导线。术后随访，无一例发生主动固定起搏电极导线脱位，复测心室电极起搏阈值、阻抗、R波高度及QRS波宽度，两组间均无显著统计学差异。结论改良主动固定起搏电极导线塑型行右室流出道间隔部起搏，方法简单，安全可靠，较传统电极塑型右室流出道间隔部起搏显著减少X线曝光、植入时间，较少损伤起搏电极导线。
목적：탐토개량주동고정기박전겁도선소형행우실류출도간격부기박적가행성여안전성。방법136례수요식입인공심장기박기，차수요식입심실주동고정기박전겁도선적환자，수궤분위량조，전통전겁소형조（CRVOTP）장전겁도선내심강사소형위쌍만삼유형상진행우실류출도간격부전겁고정；개량전겁소형조（MRVOTP）장전겁도선내심강사소형위J만진행우실류출도간격부전겁고정。결과량조균100%성공행우실류출도간격부기박，무엄중병발증，술중전겁고정차수、기박역치、조항、R파고도급QRS파관도비교，량조간균무현저통계학차이。유우MRVOTP조소형간단，용역통과삼첨판배급직접도체우실류출도간격부，X선폭광、식입시간교CRVOTP조명현축단，유현저통계학의의（P<0.05），병교소손상기박전겁도선。술후수방，무일례발생주동고정기박전겁도선탈위，복측심실전겁기박역치、조항、R파고도급QRS파관도，량조간균무현저통계학차이。결론개량주동고정기박전겁도선소형행우실류출도간격부기박，방법간단，안전가고，교전통전겁소형우실류출도간격부기박현저감소X선폭광、식입시간，교소손상기박전겁도선。
Objective To assess the feasibility and safety of using the modified active fixation pacing leads model to pace the right ventricular outflow tract septum. Methods A total of 136 patients undergoing artificial heart pacemaker implantation with active fixation pacing leads were randomized into two groups to receive conventional right ventricular outflow tract pacing (CRVOTP) or modified right ventricular outflow tract pacing (MRVOTP). The electrode lead wire core was modeled in a double-curved three-dimensional shape in CRVOTP group and in a J-shaped bend in MRVOTP group before fixation at the right ventricular outflow tract septum. Results Right ventricular outflow tract septum pacing was achieved successfully in all the patients. None of patients experienced serious complications. No significant differences were found between the two groups in the number of times of electrode fixation, pacing thresholds, impedance, R wave height or QRS wave width during the operation, but MRVOTP was associated with a reduced time of X-ray exposure and operation (P<0.05) due to the convenience in electrode modeling and in passing the leads through the tricuspid annulus and the direct access to the right ventricular outflow tract septum. Postoperative follow-up of the patients showed no incidence of active fixation pacing lead dislocation and comparable pacing thresholds of the ventricular electrodes, impedance, R wave height and QRS wave width between the two groups. Conclusion Using the modified active fixation pacing leads model to pace the right ventricular outflow tract septum can reduce the time of X-ray exposure and operation with a low probability of lead damage.