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目的探讨主动固定电极植入右心室心尖部及中位间隔部后损伤电流(current of injury,COI)的变化特点。方法入选88例右心室植入主动固定电极患者,分为右心室心尖组及中位间隔组。测定电极螺旋旋出0、5、10 min的COI及常规起搏参数,分析COI变化特点及相关关系。结果 88例患者中有2例因心腔内电图(intracardiac electrogram,ICEG)振幅过大,其产生的COI无法准确测量。剩余86例患者测定的COI在主动固定电极螺旋旋出后逐步降低,5 min测定COI与0 min相比下降[(6.6±1.5)mV vs.(7.6±1.7)mV,P<0.05],10 min测定COI与5 min相比显著下降[(5.5±1.5)mV vs.(6.6±1.5)mV,P<0.05];螺旋旋出10 min后较0 min显著降低(P<0.01)。右心室主动固定电极测定的COI在心尖组及中位间隔组的差异无统计学意义。Pearson相关分析发现,0 min测定COI与起搏阈值之间呈负相关,相关系数(r)=-0.497,P<0.01。术后2例患者电极脱位,其COI均<5.0 mV。结论右心室主动固定电极螺旋旋出后COI值逐步降低,心尖组与中位间隔组COI的差异无统计学意义。0 min测定COI与起搏阈值之间呈负相关。
Objective To investigate the changes of current injury (COI) after active fixed electrodes implantation in the apical and medial septal segments of the right ventricle. Methods 88 patients with active fixed electrode implantation in the right ventricle were divided into apical group and median group. The COI and routine pacing parameters at 0, 5, and 10 min after spiraling out of the electrode were measured, and the changes of COI and the correlation were analyzed. Results In 2 of 88 patients, the amplitude of intracardiac electrogram (ICEG) was too large, and the COI produced by it was not accurately measured. The COI measured in the remaining 86 patients decreased gradually after the active electrode was spirally screwed out. The COI decreased 5 min compared with 0 min [(6.6 ± 1.5) mV vs (7.6 ± 1.7) mV, P <0.05] (P <0.01). The COI decreased significantly compared with that of 5 min ([5.5 ± 1.5] mV vs (6.6 ± 1.5) mV, P <0.05] There was no significant difference in the COI measured by active fixed electrode of right ventricle in apical group and median interval group. Pearson correlation analysis showed that there was a negative correlation between COI and pacing threshold at 0 min, the correlation coefficient (r) = -0.497, P <0.01. Electrode dislocation occurred in 2 patients after surgery with COI <5.0 mV. Conclusions The COI value of the active fixed electrode in the right ventricle is gradually decreased after spirally screwing out. There is no significant difference in the COI between apical group and median septum group. The COI was negatively correlated with the pacing threshold at 0 min.