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目的:探讨心房螺旋电极导线植入术后起搏阈值的急性变化,用以评价心房螺旋电极导线植入是否有效、安全。方法:收集2015年11月至2016年6月期间在我院植入埋藏式人工心脏双腔起搏器、且心房植入螺旋电极导线的患者68例,根据患者植入术中即刻起搏阈值是否>1 V分为高阈值组和低阈值组2组,记录患者在植入术中即刻,术后1、3、6、24 h的起搏参数变化及并发症等情况。结果:68例患者中术中即刻起搏阈值≤1 V的低阈值组患者35例(51%),平均起搏阈值为(0.79±0.20)V,术后1 h下降为(0.69±0.34)V、3 h(0.61±0.21)V、6 h(0.59±0.19)V、24 h(0.58±0.18)V,术后3、6、24 h的起搏阈值与术中即刻相比,差异具有统计学意义(均P<0.01)。术中即刻起搏阈值>1 V的高阈值组患者33例(49%),其平均起搏阈值为(1.48±0.20)V,术后1 h下降为(0.85±0.32)V、3 h(0.74±0.23)V、6 h(0.64±0.18)V、24 h(0.60±0.24)V,术后1、3、6、24 h的起搏阈值与术中即刻相比,差异均具有统计学意义(均P<0.01)。术后除3 h外,其余各时间点间2组间起搏阈值差异均无统计学意义(均P>0.05)。结论 :心房螺旋电极导线植入术中即刻起搏阈值较高,术后降低。植入术中即刻起搏阈值高不应作为更换电极位置的标准。
OBJECTIVE: To investigate the acute changes of pacing threshold after atrial lead insertion, to evaluate whether the atrial lead electrode implantation is effective and safe. Methods: Sixty-eight patients with implantable double-chamber pacemaker implanted in our hospital from November 2015 to June 2016 were enrolled in this study. According to the immediate pacing threshold Whether> 1 V was divided into two groups: high threshold group and low threshold group. The changes of pacing parameters and complication were recorded immediately after implantation and at 1, 3, 6, and 24 h after surgery. Results: Thirty-five (51%) of the 68 low-threshold group patients with intraoperative immediate pacing threshold ≤1 V had an average pacing threshold of (0.79 ± 0.20) V and a decrease of (0.69 ± 0.34) V, 3 h (0.61 ± 0.21) V, 6 h (0.59 ± 0.19) V and 24 h (0.58 ± 0.18) V respectively. The difference of pacing threshold at 3, 6 and 24 h after operation was Statistical significance (all P <0.01). The average pacing threshold was (1.48 ± 0.20) V in the high threshold group with intraoperative immediate pacing threshold> 1 V and was (0.85 ± 0.32) V at 1 h after surgery 0.74 ± 0.23) V, 6 h (0.64 ± 0.18) V and 24 h (0.60 ± 0.24) V respectively. The differences of pacing thresholds at 1, 3, 6, 24 h after operation were statistically significant Significance (all P <0.01). Except for 3 h postoperatively, there was no significant difference in pacing threshold between the two groups at any time point (all P> 0.05). CONCLUSION: The immediate pacing threshold is higher in patients undergoing atrial spiral electrode lead implantation and decreases postoperatively. Implantation immediately pacing threshold high should not be replaced as the standard electrode position.