(2010 臺灣醫學發展基金會 得獎論文摘要)
Yu-An Chen, Kuan-Cheng Chang
Background and Purpose
Current of injury (COI) has been proposed to be valuable guidance for adequate active fixation lead placement. The aim of this study was to ascertain the hypothesis and find clinical significance from other electrical parameters in acute lead performances.
Materials and Methods
Fifty-five patients for ventricular pacing indications were enrolled. Medtronic Inc. model 5076 lead implantation was performed under fluoroscopic guidance in catheterization laboratory. Model 2290 pacing system analyzer was utilized for measurements. Data of pacing parameters were grouped by COI extent and time course for analysis.
Results
Acute pacing parameter measurements compared between COI group (n=42) and non-COI group (n=13) in pre-screw-in stage indicated that only peak R wave showed statistical difference between the two groups (15.3 ± 5.7 versus 12.2 ± 3.7 mV, p=0.04). In screw-in stage, lead impedance and peak R wave were significantly higher of COI group than those of non-COI group (812 ± 161 versus 696 ± 143 ohms, p=0.02; 18.9 ± 8.8 versus 11 ± 4.5mV, p=0.001). In post-screw-in stage, all measured parameters did not show statistical differences between COI and non-COI groups. In addition, there was a positive linear correlation between screw-in lead impedance and ST-segment elevation (n=55, r=0.32, p=0.02).
Conclusions
The development of COI during initial lead fixation did not carry significant prediction for adequate lead placement in our research. In addition, relatively high screw-in impedance was not necessarily associated to poor lead fixation as long as it fell within acceptable values in the post-screw-in phase.
Key words
current of injury, active fixation, pacing lead, pacing parameters
