主动电极的优势-2017年10月.ppt

主动电极的应用 桐城市人民医院 心内科 何林生 右室流出道间隔部和心尖部起搏对心功能和重构影响 83例缓慢心律失常患者随机分右室流出道（RVOT）和右室心尖部（RVA）起搏组。 随访一年后RVA组左室舒张末内径较术前显著增加，(53.53±5.72mm vs 50.03±6.20mm ，P﹤0.05)，两组1年后LVEF均较术前显著降低（RVOT、RVA比较分别为0.57±0.10 vs 0.62±0.11，0.53±0.08 vs 0.63±0.10 P ﹤0.01） 结论：RVOT起搏对心室重构影响好于RVA起搏。 [参阅：李萍、石泉等，右室流出道间隔部和心尖部起搏对心功能和重构影响 中国心脏起搏与心电生理杂志 2011年第25卷第1期] 右室心尖部及右室流出道起搏电极参数 电极参数随访3年195例，参数没有变化。 结论：螺旋电极在右室流出道起搏是安全的。 主动与被动电极即刻起搏参数比较，主动电极阻抗的差异示由于植入部位的不同，主动与被动电极阈值、感知和阻抗的差异是由于电极类型的不同。 * Numerous acute and chronic clinical studies have been conducted to compare the hemodynamic differences between RV-apical-paced and RVOT-paced patients, yet the results vary. However, closer examination of the data reveals more similarities than differences. De Cock, CC, et al. Europace 2003;5:275-8 * P wave duration two weeks after implant during sinus rhythm and atrial pacing in patients with atrial leads in Bachmann’s bundle region (n=60) versus the right atrial appendage. *P , 0.05 vs. via paired t-test. ?P , 0.05 via one-way ANOVA on ranks with Dunn’s adjustment for multiple comparisons. * Changes in mechanical AV delay determined from atrial pressure (AVDA): The RAA regions and CSO regions had the shortest mechanical delays, indicating the longest inter-atrial conduction delays. Left-sided sites including PVR, HAS, and LAA+HAS had the longest mechanical delays; hence the shortest conduction delays. Data are mean ±SD; *p0.05 vs. RAA, ?p0.05 vs. CSO [2-way RM ANOVA]. N=22 patients undergoing EP study for PV ablation of parox AF. RAA – right atrial appendage CSO – coronary sinus ostium PVR – left atrial pulmonary venous region CSM – mid coronary sinus LAA – left atrial appendage HAS – high right atrial septum * This trial studied 120 patients with paroxysmal AF history and brady pacing indication in two groups: RAA vs. high atrial septum (Bachmann’s Bundle). The primary endpoint was survival free from chronic AF (clinical definition). * * Numerous acute and chronic clinical studies have been conducted