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目的探讨损伤电流(COI)与主动起搏电极导线稳定性的关系,为临床上判断起搏电极导线固定的可靠性提供依据。方法 Langendorff法灌流离体兔心,应用起搏分析仪采集并记录电极接触、半旋入及全旋入心内膜时产生的腔内心电图,观察COI变化特征,比较三者的COI持续时间及大小,分析COI与电极固定牢靠度的相关性。结果螺旋电极COI大小,即R波起始后80 ms时的ST段振幅(ST80ms)、ST80ms/R及ICEG时程随时间的延长而逐渐减小(P<0.01)。全旋入电极COI持续时间为30.05±11.38 min,半旋入电极持续5.49±2.41 min,接触电极则在1.04±0.47 min内迅速消失(P<0.01)。全旋入电极在大部分时点产生的COI最大,接触电极最小,半旋入电极介于二者之间(P<0.001)。COI大小与水平相匀速牵拉导线至脱离心内膜所需拉力呈正相关(n=24,r=0.762 5,P<0.001)。结论 COI大及持续时间长均提示电极固定良好。
Objective To investigate the relationship between the injury current (COI) and the stability of the active pacemaker lead, and provide the basis for judging the reliability of the pacemaker lead in clinical practice. Methods Langendorff method was used to perfuse the isolated rabbit hearts. The intracardiac electrocardiogram (ECG) generated when the electrodes were touched, hemisphed, and fully screwed into the endocardium was collected and recorded with a pacing analyzer. The changes of COI were observed. The duration of COI and Size, analysis of the COI and electrode fixation of the reliability. Results The COI size of spiral electrodes, that is, ST segment amplitude (ST80ms), ST80ms / R and ICEG duration at 80 ms after R wave initiation, gradually decreased with time (P <0.01). The duration of COI was 30.05 ± 11.38 min, the duration of semi-spiral electrode continued for 5.49 ± 2.41 min, and the contact electrode disappeared rapidly within 1.04 ± 0.47 min (P <0.01). The total COI generated by the fully rotating electrode was the largest at most of the time, the contact electrode was the smallest, and the half-rotating electrode was between the two (P <0.001). There was a positive correlation between the size and level of COI and the pulling force needed to pull the wire out of the endocardium (n = 24, r = 0.762 5, P <0.001). Conclusions Both large COI and long duration suggest that the electrode is well fixed.