CAJ | 학술논문

目的明确不同起搏导线在植入过程中产生的损伤电流(COI)形态及变化特征.方法经起搏分析仪及体表心电图仪同步记录右心室螺旋及翼状导线、左心室心脏静脉导线及埋植多年的右心室起搏导线产生的腔内心电图(ICEG),动态观察其形态及COI变化特征.COI大小指标包括J点后80 ms处的ST段振幅(ST80),ST80与自身R波振幅之比(ST80/R)以及ICEG时限(IED).结果共记录81根起搏导线的ICEG,包括48根螺旋导线、21根翼状导线、6根左心室心脏静脉导线和6根埋植多年的起搏导线.两种方法均记录到螺旋及翼状导线产生的COI;起搏分析仪描记的螺旋导线固定10 min的ST80[(7.7±2.7)mV对(5.1±0.6) mV],ST80/R[(0.62±0.24)对(0.54±0.07)]及IED[(233.6±33.7) ms对(211.5±29.3)ms]与固定0 min相比,差异无统计学意义(P＞0.05);而翼状导线固定10 min的ST80[(5.6±2.8)mV对(0.8±0.6) mV,P＜0.01],ST80/R[(0.39±0.12)对(0.01±0.01),P＜0.05]及IED[(145.4±79.4) ms对(64.3±19.8)ms,P＜0.01)]与固定0 min相比大幅减小,且大部分时间点的ST80、ST80/R值均较螺旋导线的相应值小(P＜0.05).总体上,体表心电图仪记录到相似的COI变化趋势.左心室心脏静脉导线及埋植多年的起搏导线均无COI产生.结论螺旋导线与翼状导线相比,COI值较大,持续时间较长.左心室心脏静脉导线及埋植多年的起搏导线不产生COI.
목적 명학불동기박도선재식입과정중산생적손상전류(COI)형태급변화특정.방법 경기박분석의급체표심전도의동보기록우심실라선급익상도선、좌심실심장정맥도선급매식다년적우심실기박도선산생적강내심전도(ICEG),동태관찰기형태급COI변화특정.COI대소지표포괄J점후80 ms처적ST단진폭(ST80),ST80여자신R파진폭지비(ST80/R)이급ICEG시한(IED).결과 공기록81근기박도선적ICEG,포괄48근라선도선、21근익상도선、6근좌심실심장정맥도선화6근매식다년적기박도선.량충방법균기록도라선급익상도선산생적COI;기박분석의묘기적라선도선고정10 min적ST80[(7.7±2.7)mV대(5.1±0.6) mV],ST80/R[(0.62±0.24)대(0.54±0.07)]급IED[(233.6±33.7) ms대(211.5±29.3)ms]여고정0 min상비,차이무통계학의의(P＞0.05);이익상도선고정10 min적ST80[(5.6±2.8)mV대(0.8±0.6) mV,P＜0.01],ST80/R[(0.39±0.12)대(0.01±0.01),P＜0.05]급IED[(145.4±79.4) ms대(64.3±19.8)ms,P＜0.01)]여고정0 min상비대폭감소,차대부분시간점적ST80、ST80/R치균교라선도선적상응치소(P＜0.05).총체상,체표심전도의기록도상사적COI변화추세.좌심실심장정맥도선급매식다년적기박도선균무COI산생.결론 라선도선여익상도선상비,COI치교대,지속시간교장.좌심실심장정맥도선급매식다년적기박도선불산생COI.
Objective To investigate the characteristics and dynamic behaviors of current of injury (COI) observed during pacemaker lead implantation.Methods Intracardiac electrogram (ICEG) was recorded simultaneously by pacing system analyzer and conventional 12-lead surface electrocardiogram for up to 10 mins after successful lead placement.Presence of COI was characterized as elevation of ST segment and prolongation of ICEG duration (IED).COI Parameters,including ST80(amplitude of ST segment elevation at 80 ms after J point),ST80/R(ST80 divided by intrinsic R wave amplitude) and IED associated with active and passivefixation leads were measured dynamically at 0,2,5 and 10 min post lead fixation.Left ventricular(LV) coronary venous leads and those leads fixed years ago were studied as well.Pacing parameters of each pacing lead were evaluated routinely after the procedure.Results Total of 48 active-fixation leads and 21 passive fixation leads were studied,each of them showed ICEG with distinct COI.The COI magnitude of active fixation leads acquired by pacing system analyzer was maintained at a considerable level without remarkable decrease within 10 min after lead fixation:[(7.7±2.7) mV vs.(5.1 ±0.6) mV] for ST80,[(0.62±0.24) vs.(0.54±0.07)] for ST80/R and[(233.6±33.7) ms vs.(211.5±29.3) ms] for IED(10 min vs.0 min,P＞0.05).The passive-fixation leads presented relatively less pronounced ST80and ST80/R at most of the time points(passive vs.active,P＜0.05),and notable decline in COI magnitude,including ST80 [(5.6±2.8) mV vs.(0.8±0.6) mV,P＜0.01],ST80/R [(0.39±0.12) vs.(0.01 ±0.01),P＜0.05] and IED [(145.4±79.4) ms vs.(64.3± 19.8) ms,P＜0.01],occurred within 10 minutes of observation(10 min vs.0 min).In general,the surface electrogram showed similar findings.Neither left ventricular coronary venous leads nor those leads in the cases of pacemaker replacement showed significant COI.All implanted leads yield acceptable pacing parameters.Conclusion Active-fixation leads were related to COI of greater magnitude and longer time course compared to passive-fixation leads.LV coronary venous leads as well as the leads implanted years ago produced ICEG without COI.