不同品牌植入式心律转复除颤仪与起搏分析仪术中测量参数的比较研究
发布时间：2018-11-15 07:02
【摘要】：目的:植入式心脏转复除颤仪(ICD)的感知功能是其发挥除颤功能的前提,ICD植入术中利用起搏分析仪所测得的R波振幅是ICD感知功能正常工作的基础。本研究旨在通过对比分析不同品牌ICD与起搏分析仪术中所测参数的差异来帮助临床医师了解不同品牌ICD的特点。方法:入选2015年9月至2015年12月在南京鼓楼医院心脏科因心律失常需植入心血管植入电子装置(CIED)的患者。术前收集其临床基本资料及相关检查结果,术中利用不同品牌ICD样机和5318起搏分析仪分别测试R波振幅、阻抗等参数,并通过程控分析仪打印ICD所记录的腔内心电图。术后手动测量腔内心电图上的R波振幅及T波振幅并计算两者差值,定义该值为R波安全余量。利用配对t检验比较不同品牌ICD及5318起搏分析仪所测得的R波振幅、阻抗及不同品牌ICD所对应的R波安全余量,观察并比较不同品牌ICD所感知腔内心电图形态。结果:共30例患者入选本研究,最终获得了 30例患者的起搏分析仪所测R波振幅及阻抗,30例患者美敦力ICD、波科ICD及百多力ICD所感知的R波振幅、阻抗及腔内心电图,22例患者圣犹达ICD所感知的R波振幅、阻抗及腔内心电图。研究发现:1.同一患者不同品牌ICD所感知的腔内心电图所示QRS波主要有"qR""、"rSr"、"RQr"这3种形态,T波主要有被完全滤过或过滤为负向波形这两种处理结果。2.术中5318起搏分析仪所测得R波振幅平均为14.1±4.3mv,高于不同品牌ICD所测R波振幅,有统计学差异(P≤0.001),美敦力ICD所测R波振幅最低,为7.9±3.1mv。3.手测腔内心电图R波振幅与机测值存在一定差异,百多力ICD和波科ICD所测R波振幅与腔内心电图R波振幅手测值得差异无统计学意义。在R波安全余量方面,波科ICD腔内心电图R波安全余量最高为12.0±3.1mv,仅圣犹达ICD腔内心电图R波安全余量与之相比无统计学差异(12.0±3.1mvVS10.9±2.6mv,P=0.667)。4.不同品牌ICD术中测试导线阻抗与5318起搏分析仪术中测试阻抗的差异有统计学意义,5318起搏分析仪所测阻抗最高为 823±261 Ω。结论:1.不同品牌ICD感知的腔内心电图形态不同,R波振幅、T波振幅及形态存在明显差异,这可能与不同品牌ICD采用的感知算法及带通滤波器不同有关;2.不同品牌ICD术中测试的R波振幅低于5318起搏分析所测R波振幅,且不同品牌ICD所测R波振幅之间也存在差异,这提示在ICD植入术中利用5318起搏分析仪测定R波振幅时对应不同品牌ICD存在不同的最低要求值;不同品牌ICD的R波安全余量存在差异,该差异可能与不同品牌ICD的T波过感知发生率有关,其临床意义还有待进一步探索;3.不同品牌ICD术中所测导线阻抗与5318起搏分析仪所测导线阻抗存的差异有统计学意义,但该差异不足以影响术后利用阻抗变化幅度判断导线完整性的功能。
[Abstract]:Aim: the perceptual function of (ICD) is the premise of defibrillation. The amplitude of R wave measured by pacing analyzer in ICD implantation is the basis of normal function of ICD. The purpose of this study was to help clinicians understand the characteristics of different brands of ICD by comparing and analyzing the differences of intraoperative parameters between different brands of ICD and pacemaker analyzers. Methods: from September 2015 to December 2015, patients in Department of Cardiology of Nanjing Gulou Hospital needed to implant cardiovascular device (CIED) due to arrhythmia. The basic clinical data and related examination results were collected before operation. The parameters of R wave amplitude and impedance were measured by different brand ICD prototype and 5318 pacemaker analyzer respectively. The intracavitary electrocardiogram recorded by ICD was printed by program control analyzer. The R wave amplitude and T wave amplitude were measured manually after operation and the difference between them was calculated, which was defined as the R wave safety margin. The R wave amplitude, impedance and R wave safety margin of different brands of ICD and 5318 pacemaker analyzer were compared by paired t test, and the electrocardiogram (ECG) patterns of different brands of ICD were observed and compared. Results: a total of 30 patients were enrolled in this study. The R wave amplitude and impedance measured by pacemaker analyzer were obtained in 30 patients. The R wave amplitude, impedance and intracavity electrocardiogram (ECG) were detected by Medtronic ICD, wave ICD and Baidol ICD in 30 patients. The R wave amplitude, impedance and intracavity electrocardiogram (ECG) perceived by St Juda ICD in 22 patients. The results are as follows: 1. The QRS waves perceived by different brands of ICD in the same patient were mainly "qR", "rSr" and "RQr", and T waves were completely filtered or filtered into negative waveforms. 2. The average amplitude of R wave measured by 5318 pacing analyzer during operation was 14.1 卤4.3 MV, which was higher than that measured by different brands of ICD (P 鈮，
本文编号：2332489
[Abstract]:Aim: the perceptual function of (ICD) is the premise of defibrillation. The amplitude of R wave measured by pacing analyzer in ICD implantation is the basis of normal function of ICD. The purpose of this study was to help clinicians understand the characteristics of different brands of ICD by comparing and analyzing the differences of intraoperative parameters between different brands of ICD and pacemaker analyzers. Methods: from September 2015 to December 2015, patients in Department of Cardiology of Nanjing Gulou Hospital needed to implant cardiovascular device (CIED) due to arrhythmia. The basic clinical data and related examination results were collected before operation. The parameters of R wave amplitude and impedance were measured by different brand ICD prototype and 5318 pacemaker analyzer respectively. The intracavitary electrocardiogram recorded by ICD was printed by program control analyzer. The R wave amplitude and T wave amplitude were measured manually after operation and the difference between them was calculated, which was defined as the R wave safety margin. The R wave amplitude, impedance and R wave safety margin of different brands of ICD and 5318 pacemaker analyzer were compared by paired t test, and the electrocardiogram (ECG) patterns of different brands of ICD were observed and compared. Results: a total of 30 patients were enrolled in this study. The R wave amplitude and impedance measured by pacemaker analyzer were obtained in 30 patients. The R wave amplitude, impedance and intracavity electrocardiogram (ECG) were detected by Medtronic ICD, wave ICD and Baidol ICD in 30 patients. The R wave amplitude, impedance and intracavity electrocardiogram (ECG) perceived by St Juda ICD in 22 patients. The results are as follows: 1. The QRS waves perceived by different brands of ICD in the same patient were mainly "qR", "rSr" and "RQr", and T waves were completely filtered or filtered into negative waveforms. 2. The average amplitude of R wave measured by 5318 pacing analyzer during operation was 14.1 卤4.3 MV, which was higher than that measured by different brands of ICD (P 鈮，
本文编号：2332489
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