OBJECTIVE: To evaluate prospectively the efficacy of intraprocedural 2-dimentional-transthoracic echocardiography (2DTTE) in reducing/preventing lead-associated TR.
METHODS: We conducted a prospective randomized controlled study comparing echocardiographic results in patients undergoing de-novo PPM/ICD implantation with intraprocedural echo-guided right ventricular (RV) lead placement (Group 1, n=56) versus non-echo guided implantation (Group 2, n=55). Lead position was changed if TR grade was more than baseline in Group 1. Cohort patients underwent 2DTTE at baseline and 3 and/or 6 months after implantation. Excluded were patients with baseline TR > moderate or baseline ≥ moderate RV dysfunction.
RESULTS: The study comprised 111 patients (74.14 ± 11 years of age, 58.6% male, 19% ICD, 42% active leads). In 98 patients there was at least one follow-up echo. Two patients from Group 1 (3.6%) needed intraprocedural RV electrode repositioning. Four patients (3.5%, 2 from each group, all dual chamber PPM, 3 atrial fibrillation, 2 RV pacing > 40%, none with intraprocedural reposition) had TR deterioration during 6 months follow-up. One patient from Group 2 with baseline mild-moderate aortic regurgitation (AR) had worsening TR and AR within 3 months and underwent aortic valve replacement and TV repair.
CONCLUSIONS: The rate of mechanically induced lead-associated TR is low; thus, a routine intraprocedural 2DTTE does not have a significant role in reducing/preventing it.
目的:前瞻性评估术中二维经胸超声心动图(2DTTE)在降低/预防导线相关TR方面的功效。
方法:我们进行了一项前瞻性随机对照研究,比较了行术中回声引导右心室(RV)导线置入的患者(第1组,n=56)和非回声引导植入(第2组,n=55)的超声心动图结果。如果在第1组中TR等级大于基线,则改变导线位置。队列患者在基线和植入后3和/或6个月接受2DTTE。排除基线TR>中度或基线≥中度RV功能障碍的患者。
结果:该研究包括111名患者(74.14±11岁,58.6%男性,19%ICD,42%的活性引线)。98例患者至少有一次随访回声。第1组的两名患者(3.6%)需要术中重新定位RV电极。4名患者(3.5%,每组2个,所有双腔PPM,3房颤,2RV起搏>40%,在6个月的随访中,没有人进行术中复位)的TR恶化。第2组的一名患者基线轻度-中度主动脉瓣反流(AR)在3个月内TR和AR恶化,并接受了主动脉瓣置换术和电视修复。
结论:机械诱导的铅相关TR的发生率较低;因此,常规术中2DTTE在减少/预防方面没有显著作用.