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目的 分析永久心脏起搏器心房被动导线置入失败的危险因素,为避免二次手术或增加手术难度提供依据.方法 回顾性分析2011年1月至2016年12月所有置入双腔起搏器的患者,分为主动电极组(因各种原因置入被动电极失败而更换为主动电极)和被动电极组(成功置入被动心房电极),根据两组临床资料分析心房被动电极置入失败而更换为主动电极的危险因素.结果 被动电极组583例,主动电极组30例.两组资料单因素分析显示主动电极组男性较多,左房及右房室较大,患有心肌病、心功能不全、阵发性心房颤动、陈旧性心肌梗死、心脏结构异常以及具有心外科手术病史的患者均较被动电极组比例增加(P<0.05).多因素Logistic回归分析显示右房扩大(OR=1.12,95％CI:1.04～1.20)、严重心功能不全(左室射血分数<0.35)(OR=6.78,95％CI:2.00～22.95)、具有阵发性心房颤动病史(OR=2.82,95％CI:1.02～7.80)和具有心外科手术病史(OR=126.57,95％CI:36.26～441.80)的患者均为心房被动导线置入失败的独立危险因素.结论 右房扩大、严重心功能不全、具有阵发性心房颤动病史和具有心外科手术病史的患者是置入心房被动导线失败的独立危险因素,对于这些患者可直接选择置入心房主动螺旋电极.“,”Objective To analysis the risk factors of failure of implantation of atrial passive lead in permanent pacemaker,and provide the evidence for preventing reoperation and increasing the difficulty of the operation. Methods Patients who received dual-chamber pacemaker from January 2011to December 2016were retrospectively analyzed.The patients were subdivided into active lead fixation group(for various reasons failure of implantation of atrial passive lead replacement for the active lead)and passive lead group (successfully implanted atrial passive lead).According to the clinical data of two groups,the risk factors of failure of implantation of atrial passive lead were analyzed. Results Single factor analysis showed that compared with passive lead group,the percentage of male,cardiomyopathy,heart failure,paroxysmal atrial fibrillation,history of myocardial infarction,cardiac structural abnormalities,history of cardiac surgery and the diameter of left atrial and right atrial and ventricular both increased in active lead fixation group.Multiple-factors Logistic regression analysis showed that the right atrial enlargement(OR=1.12,95％CI:1.04-1.20),severe cardiac insufficiency(left ventricular ejection fraction<0.35) (OR=6.78,95％CI:2.00-22.95),with a history of paroxysmal atrial fibrillation(OR=2.82,95％CI:1.02-7. 80)and history of cardiac surgery(OR=126.57,95％CI:36.26-441.80)were independent risk factors of failure of implantation of atrial passive lead. Conclusion The right atrial enlargement,severe cardiac insufficiency,with a history of paroxysmal atrial fibrillation and history of cardiac surgery are independent risk factors of failure of implantation of atrial passive lead.