Clinical Analysis Of Cardiac Pacemaker Reimplantation

Objective To reduce the complications of operation and the chance of artificial pacemaker reimplantation by study the cause and methods of pacemaker reimplantation.Methods After first operation, a long term follow-up survey was regularly carried out. Before reimplantation operation, patient routinely accepted ECG, ambulatory 24-hour electrocardiographic monitoring (Holter monitoring), chest X-ray examination and telemetry. During the reimplantation operation cause, the function of cardiac pacemakers and electrode leads must be measured. All the data was recorded in detail. This article was based on follow-up survey data, operation record and case history from MAY 1981 to July 2004, to analyse the cause and methods of the pacemaker reimplantation.Result In 196 cases of pacemaker reimplantation, involving 159 patients. VVI(R) were 179 cases, AAI(R) were 6 cases, DDD(R) were 11 cases. Due to pulse generator were 137 cases (69.9%), due to electrodes fracture or insulating layer breakage were 14 cases(7.1%), due to electrodes dislodge were 14 cases(7.1%), due to infection were 13 cases(6.6%), due to skin mechanic erosion were 7cases(3.6%), due to pacing threshold increase were 5 cases(2.6%), due to screw loosening were 3 cases(1.6%), due to wound disunion were 2 cases(l%), due to pocket hematoma was 1 case(0.5%).Lead parameters of 92 VVI(R) pacemakers replaced for battery normally exhausting in this group were compared with 92 ventricular leads implanted for the first time. Pacing threshold during pulse generator reimplantation was about 3 timeshigher than during leads implanted for the first time (P < 0.01), there were obvious difference. There were no significant difference in lead impedance (P > 0.05) and no significant difference in QRS wave amplitude (P > 0.05).Conclusion 1 .Although the main cause of pacemaker reimplantation was pulse generator battery exhausting, operation complications still could not be disregarded. To reduce the complications will decrease the chance of reimplantation. 2.Although the pacing threshold during pulse generator reimplantation were about 3 times higher than leads implanted for first time, there were still no obvious change in lead impedance and QRS wave amplitude.