437例兼容磁共振心脏植入装置临床应用的回顾性分析

发布时间：2018-11-06 12:49

【摘要】：目的探讨兼容磁共振(MRI)心脏植入装置(CIED)的临床应用及其安全性。方法回顾性分析自2014年6月至2016年11月在浙江大学附属第二医院心血管内科成功植入兼容MRI心脏植入装置患者437例。收集患者的基本临床资料、植入CIED信息、随访统计患者术后48小时、术后1、3、6月的起搏导线参数,MRI检查情况及并发症。结果437例患者,男性246例,女性191例,平均69.1 ± 12.9岁。起搏器置换患者2例,首次CIED植入患者435例,其中15例为植入型心律转复除颤器(ICD),2例为心脏再同步治疗起搏器/除颤器(CRT-P/D)。所有患者术中无并发症发生;术后发生2例(0.45%)导线移位,24例(5.49%)患者接受MRI检查,未观察到相关不良事件,导线参数在MRI检查前后保持稳定。术后48小时右房及右室感知(右房/右室 3.5±1.9mV/13.2±5.3mV)较术中(右房/右室 3.1±1.5mV/10.8±6.3mV)增大,差异有统计学意义(p0.05);术后48小时右房及右室起搏导线阻抗(右房/右室517 ± 85Ω/602 ± 105Ω)较术中(右房/右室624 ± 149Ω/740 ±165Ω)明显下降,差异有统计学意义(p0.05);术后48小时右房起搏阈值(0.79±0.27V)较术中(1.03 ±0.68)下降,但差异无计学意义(p0.05),右室起搏阈值较术中未见显著性变化。起搏导线参数术后48小时及术后1～6月随访未见显著性变化。结论兼容磁共振CIED能安全起搏,适应特定条件下的MRI检查,短期随访起搏器工作状态稳定。
[Abstract]:Objective to investigate the clinical application and safety of magnetic resonance (MRI) compatible cardiac implants (CIED). Methods from June 2014 to November 2016, 437 patients with compatible MRI cardiac implants were successfully implanted in Department of Cardiovascular Medicine, second affiliated Hospital of Zhejiang University. The basic clinical data of the patients were collected, CIED information was implanted, and the pacing lead parameters, MRI examination and complications of 48 hours, 1 ~ 3 and 6 months postoperatively were followed up. Results there were 437 patients, 246 males and 191 females, with an average age of 69.1 卤12.9 years. There were 2 patients with pacemaker replacement, 435 patients with first CIED implantation, 15 patients with implantable cardioverter defibrillator (ICD),) and 2 patients with cardiac resynchronization therapy pacemaker / defibrillator (CRT-P/D). 2 cases (0.45%) were transposed and 24 cases (5.49%) underwent MRI examination. No related adverse events were observed, and the traverse parameters remained stable before and after MRI examination. 48 hours after operation, the perception of right atrium and right ventricle (3.5 卤1.9mV/13.2 卤5.3mV) was significantly higher than that during operation (3.1 卤1.5mV/10.8 卤6.3mV). The impedance of right atrial and right ventricular pacing conductors (517 卤85 惟 / 602 卤105 惟) at 48 hours after operation was significantly lower than that during operation (624 卤149 惟 / 740 卤165 惟) (p0.05). The threshold of right atrial pacing (0.79 卤0.27V) was lower than that of intraoperative pacing (1.03 卤0.68) 48 hours after operation, but there was no significant difference (p0.05). There were no significant changes in pacing lead parameters 48 hours after operation and 1 ~ 6 months after operation. Conclusion compatible magnetic resonance CIED is safe for pacing, suitable for MRI examination under specific conditions, and stable in working state of pacemakers in short term follow-up.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R541

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