| Part One. Upper Extremity Deep Venous Obstruction Does Not Increase After Transvenous Permanent Implantation of PacemakerObjective To determine the incidence and risk factors for venous obstructions in patients after implantation of transvenous permanent pacemaker(PM) in Chinese.Methods The study group consisted of the patients referred for implantation of permanent dual-chamber pacemaker. All patients who were classified into two groups as group A(4.1Fr) or group B(6Fr) by the outer diameter of ventricular pacing lead underwent Duplex color ultrasonography of the upper extremity deep vein before and following PM implantation(3and6months after implanted PM, respectively). The incidence and predictors of venous obstruction before and after permanent PM implantation in all patients and group A and B were analysed and compared.Results Sixty-seven referred for PM implantation consisted of the study population. Duplex color ultrasonography of bilateral upper extremity deep vein(UEDV) were performed before implanted PM in52cases, including one patient with severe stenosis of the proximal part of her left subclavian vein. Following PM implantation, ultrasonography of UEDV ipsilateral to pacemaker implant were performed separately in40and44cases at3and6months after PM implantation. Thirty-two patients underwent ultrasonography before PM implantation and six months later and twenty of them also underwent ultrasonography three months after PM implantation. After six months follow-up, the inner diameter of UEDV ipsilateral to PM implant decreased slightly compared to that before PM implantation in the32cases, especially for axillary vein(P<0.05). The inner diameter of UEDV in group B is thicker than in group A before PM implantation, but there were no significant differences.Conclusion The incidence of venous obstruction after transvenous permanent pacemaker implantation is rare in Chinese. It is not necessary to monitor whether there is venous obstruction or not after PM implantation by Duplex color ultrosonngraphy regularly. Part Two. Tricuspid Regurgitation Does Not Increase Early After Permanent Implantation of Pacemaker leadsObjective To investigate the effect of transvenous implantation of right ventricular pacing lead on tricuspid regurgitation(TR).Methods This study group consisted of tirty-six patients referred for implantation of permanent pacemaker(PM), a4.1Fr ventricular pacing lead was used in20patients(group A) and a6.6Fr lead in16patients(group B). All patients underwent two-demensional and Doppler echcardiography before and after device implantation. The severity of TR was qualitatively classified into seven group as normal(0),trivial(1), mild(2), mild-moderate(2.5), moderate(3), moderate-severe(3.5), or severe(4).Results Echocardiographic degree of TR was normal in7(19%, trivial in18(50%), mild in8(22%), mild-moderate in2(6%) and moderate in1(3%) patients before PM implantation. Following device implantation, normal TR was noted in3(8%), trivial in26(50%), mild in4(11%), mild-moderate in2(6%) and moderate in1(3%) cases. After the procedure, the TR severity in group A was increased from normal to trivia in2cases and decrease from mild to trivial in5and from trivial to normal in1. In group B, the severity of TR was increased from normal to trivial in2cases, from trivial to mild in2, from mild-moderate to moderate in1and decreased from trivial to normal in1, from mild to trivial in1, from moderate to mild-moderate in1The severity of TR, which was quantified as0(normal),1(trivial),2(mild),2.5(mild-moderate),3(moderate), was slightly decreased(p>0.05) and increased (p>0.05)in group A and B after implantation of PM, respectively. However, the pulmonary systolic pressure was increased slightly in both group A and B after the procedure.Conclusion The severity of TR does not worse after tranvenous implantation of single right ventricular endocardial pacing lead within6months and is likely to decrease after implantation of a4.1Fr pacing lead.
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