LONG-TERM PERFORMANCE OF EPIMYOCARDIAL PACING LEADS IN ADULTS - COMPARISON WITH ENDOCARDIAL LEADS
LONG-TERM PERFORMANCE OF EPIMYOCARDIAL PACING LEADS IN ADULTS - COMPARISON WITH ENDOCARDIAL LEADS
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DOI：
10.1111/j.1540-8159.1993.tb01603.x
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发表时间：
1993-03-01
影响因子：
1.8
通讯作者：
PINSKI, SL
中科院分区：
文献类型：
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作者：
HELGUERA, ME;MALONEY, JD;PINSKI, SL
心外膜起搏导线在儿童中的长期表现是公认的，但很少有研究分析成人的表现。鉴于植入心律转复除颤器和抗心动过速起搏系统的心外膜电极的使用日益增多，这一问题具有临床意义。我们分析了自1980年1月以来植入的93个心外膜起搏系统(121个导联：65个单极，28个双极)，这些起搏系统在成年患者(年龄57+/-16岁)中植入。研究人员研究了两种不同的型号：美敦力4951“刺入”(n=35)和美敦力6917/6917A“拧入”(n=58)。对照组是根据植入的年龄和年份，将每个心外膜系统与两个心内膜导联随机匹配。心外膜和心内膜导联分别随访44+/-35个月和43+/-35个月(P=NS)。心外膜导联5年的无失败发生率为0.91(95%可信区间[95%CI]=0.82~0.96)，10年后为0.91(95%CI=0.69~0.98)。两种分析模型之间没有发现差异。心内膜电极置换率5年为0.97(95%CI=0.93~0.99)，10年为0.90(95%CI=0.61~0.97)。心外膜导联的短期存活率明显低于心内膜导联，其次是早期的“技术相关”失败(P=0.03；相对风险3.0；Wilcoxon检验)。然而，总体长期表现与心内膜导联相似。心外膜起搏导线经过精心植入和测试，具有与心内膜起搏导线相似的长期性能。
The long-term performance of epimyocardial pacing leads in children is well established, but few studies have analyzed the performance in adults. This issue has clinical relevance in view of the increased use of epimyocardial leads with implantable cardioverter defibrillator and antitachycardia pacing systems. We analyzed 93 epimyocardial pacing ''systems'' (121 leads: 65 unipolar, 28 bipolar) in adult patients (age 57 +/- 16 years), implanted since January 1980. Two different models were studied: Medtronic 4951 ''Stab-on'' (n = 35) and Medtronic 6917/6917A ''Screw-in'' (n = 58). A control group was created by randomly matching each epimyocardial system with two endocardial leads, according to age and year of implant. Epimyocardial and endocardial leads were followed-up for 44 +/- 35 and 43 +/- 35 months, respectively (P = NS). Freedom from failure for epimyocardial leads was 0.91 (95% Confidence Interval [95% CI] = 0.82 to 0.96) at 5 years, and 0.91 (95% CI = 0.69 to 0.98) at 10 years. No difference was found between the two analyzed models. Freedom from failure for endocardial leads was 0.97 (95% CI = 0.93 to 0.99) and 0.90 (95% CI = 0.61 to 0.97) at 5 and 10 years, respectively. Epimyocardial leads had a significantly poorer short-term survival than endocardial leads, secondarily to earlier ''technique related'' failures (P = 0.03; relative risk 3.0; Wilcoxon test). However, overall long-term performance was similar to endocardial leads. Epimyocardial pacing leads, meticulously implanted and tested, have a long-term performance similar to endocardial pacing leads.