| Objective: The development history of cardiac pacemaker pacing lead go through from passive to active pacing lead.Emergence of active pacing lead reduce passive pacing lead high dislocation rate and improve fixed position inconvenient adjustment.After active pacing lead implantation,short-term pacing threshold can be a big change.Instant pacing threshold and pacing threshold of active fixed pacing lead 5-10 minutes after implantation is defined as short-term pacing threshold. To explore the influence factor of active fixed pacing lead after implantation of cardiac pacemaker in short-term pacing threshold.Analysis change of myocardial injury markers after the active pacing lead implanted.To know whether the application of active pacing lead with myocardial injury and evaluation of damage degree.Methods:1 Object: From sep 2012 to sep 2014 in our hospital cardiovascular internal medicine cardiac pacemaker therapy(cardiac pacemaker) and active fixed pacing lead implanted in 192 patients, 93 cases of male, female 99 cases, average age 67.61 ± 8.91(41 to 88 years). Sick sinus syndrome in 156 cases, Ⅱ°atrioventricular block 9 cases, Ⅲ°atrioventricular block 18 cases, and change the 9 cases of sexual function. 136 patients with one active fixed pacing lead used in it, the two leads of 56 patients with active fixed pacing lead. And collect the clinical data of all patients were in line with the 2008 ACC/AHA/HRS abnormal heart rhythm of plant treatment guidelines Ⅰclasses and class a indication.Ⅱ2 All patients were examined before electrocardiogram, chest X-ray, echocardiogram, myocardial enzyme, BNP, biochemical examination such as whole, drugs to patients in preoperative antiplatelet discontinuation; All of the patients are all one-time active fixed pacing lead implanted successfully. Intraoperative monitoring of active fixed pacing lead implanted atrial or ventricular after short-term pacing threshold, and record the patient general condition including gender, age, smoking, drinking and associated with diseases such as hypertension, diabetes, coronary heart disease, hyperlipidemia, etc.3 Statistical method: Using multiariable Logistic regression analysis of cardiac pacemaker after active fixed pacing lead implanted in the short term, in general, the impact on the threshold of the wrestle since. And in preoperative and postoperative 24 h, 48 h, or even 72 h monitoring myocardial enzymes, the myocardial enzyme levels in different time and the comparison between two groups using repeated measures design analysis of variance, evaluation of active fixed pacing lead for myocardial damage degree, understand its security.Result:1 By gender, age, hypertension, coronary heart disease, diabetes, hyperlipidemia, smoking and drinking as independent variables, with ventricular active fixed pacing lead spiral spin out immediately after pacing threshold do logistic regression analysis for the dependent variable, the results showed that coronary heart disease, diabetes, hyperlipidemia, smoking and drinking to the influence factors of ventricular instant pacing threshold; With ventricular active fixed pacing lead spiral spin out 5-10 minutes after the threshold for the dependent variable of logistic regression analysis, the results showed that women, older age, diabetes, alcohol as the influence factors of ventricular 5-10 minutes pacing threshold; With atrial active fixed pacing lead spiral spin out immediately after pacing threshold do logistic regression analysis for the dependent variable, the results showed that coronary heart disease, smoking, the influence factors of atrial pacing immediate threshold; With atrial active fixed pacing lead spiral spin out 5-10 minutes after pacing threshold do logistic regression analysis for the dependent variable, the results showed that diabetes, smoking, 5-10 minutes for atrial pacing threshold of influence factors.2 Different time of myocardial enzyme levels. Preoperative serum myoglobin(MYO) level was 58.11 ± 23.70 ng/ml, creatine kinase(CK) concentration was 66.02 ± 33.02 U/L, creatine kinase isoenzyme(CK-MB) concentration was 16.03±9.49U/L,lactate dehydrogenase(LDH) concentration was 193.00±49.94 U/L, troponin I(c Tn I) concentration was 0.01±0.01 ng/ml. Serum myocardial enzyme myoglobin(MYO) concentration of preoperative and postoperative different time difference was statistically significant(F=36.196, P<0.001),concentration of 24 hours after the operation elevated(P<0.05); Creatine kinase(CK) concentration of preoperative and postoperative different time difference was statistically significant(F= 39.075, P<0.001), concentration of 24 hour and 48 hours after the operative elevated(P<0.05); Creatine kinase isoenzyme(CK-MB) concentration of preoperative and postoperative different time difference was statistically significant(F =11.469, P<0.001), concentration of 24 hours after the operation elevated(P<0.05); Lactate dehydrogenase(LDH) concentration of preoperative and postoperative different time difference was statistically significant(F=25.430).Troponin I(c Tn I) concentration of preoperative and postoperative different time difference was statistically significant(F=21.456).concentration of 24 and 48 hours after the operation elevated(P<0.05).3 Myocardial enzyme levels, different groups are compared. Serum myoglobin(MYO) level of the one and two leads group and there was no statistically significant difference between two groups(F=0.758, P=0.758). Creatine kinase(CK) concentration difference between the one lead and the two leads groups has no statistical significance(F=0.453, P=0.502); Creatine kinase isoenzyme(CK-MB) concentration difference between the one lead and the two leads groups has no statistical significance(F=3.740, P=3.740). Lactate dehydro- genase(LDH) concentration of the one and two leads group and there was no statistically significant difference between two groups(F=0.865, P=0.354); Troponin I(c Tn I) concentration difference between the one lead and the two leads groups has no statistical significance(F=0.054, P=0.054).Conclusions: this study shows that: female, age, smoking, drinking, coronary heart disease, diabetes, hyperlipidemia, heart pacemakers is influence factors of pacing threshold active fixed pacing lead in the short term after implantation.After active fixed pacing lead implanted in patients,myocardial enzyme MYO,CK,CK-MB,LDH,c TNI can be increased peak on 24 hours a day and significantly higher than preoperative(P<0.05), but 72 hours can drop to normal or below the preoperative level. There is no statistically significant significant difference of myocardial enzyme levels active pacing leads between single and two leads group(P>0.05).There is no clear effect on myocardial injury active pacing leads implanted.Myocardial injury and the number of active pacing lead have no obvious correlation. |
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