2025 年第 2 期 第 20 卷

影响心脏植入式电子设备导线脱位的危险因素分析

Analysis of risk factors for lead dislocation in cardiac implantable electronic devices

作者：朱博韬1李海威1刘雨桐1崔乃元1刘桓甫1孙卫平1钱满1袁钟毓2张晓萍3吴永全1

英文作者：Zhu Botao1 Li Haiwei1 Liu Yutong1 Cui Naiyuan1 Liu Huanfu1 Sun Weiping1 Qian Man1 Yuan Zhongyu2 Zhang Xiaoping3 Wu Yongquan1

单位：1首都医科大学附属北京安贞医院心脏起搏与CIED中心，北京100029；2中日友好医院手术麻醉科，北京100029；3首都医科大学附属北京安贞医院北京市心肺血管疾病研究所高血压研究室，北京100029

英文单位：1Cardiac Pacing and CIED Center Beijing Anzhen Hospital Capital Medical University Beijing 100029 China; 2Department of Surgical Anesthesia China-Japan Friendship Hospital Beijing 100029 China; 3Hypertension Laboratory Beijing Anzhen Hospital Capital Medical University Beijing Institute of Heart Lung and Blood Vessel Diseases Beijing 100029 China

关键词：心脏植入式电子设备；导线脱位；左心室舒张末期内径；左心室射血分数

英文关键词：Cardiacimplantableelectronicdevices;Leaddislocation;Leftventricularenddiastolicdimension;Leftventricularejectionfraction

• 摘要：

• 目的 分析影响心脏植入式电子设备(CIED)导线脱位的临床危险因素。方法 选取2013年1月至2024年6月首都医科大学附属北京安贞医院收治的78例因心律失常行CIED植入术后出现导线脱位的患者为导线脱位组，并随机选取同期首都医科大学附属北京安贞医院收治的137例因心律失常行CIED植入术后未出现导线脱位的患者为未脱位组。比较2组患者的基线特征、实验室检查结果及超声检查结果。采用Logistic回归方法分析患者导线脱位的临床危险因素。结果 导线脱位组患者年龄小于未脱位组［（67±12）岁比（73±10）岁］，房室传导阻滞和心脏介入手术操作史比例高于未脱位组［46.2%(36/78)比10.9%(15/137)、23.1%（18/78）比7.3%（10/137）］（均P＜0.05）。2组实验室检查结果比较，除丙氨酸转氨酶外，差异均无统计学意义（均P＞0.05）。导线脱位组左心室舒张末期内径、左心室收缩末期内径均大于未脱位组，左心室射血分数低于未脱位组（均P＜0.05）。多因素二元Logistic回归分析结果显示，较高的左心室舒张末期内径（比值比=1.43）、较低的左心室射血分数（比值比=1.07）和房室传导阻滞病史（比值比=16.74）与导线脱位事件风险增加独立相关（均P＜0.01）。结论 较高的左心室舒张末期内径、较低的左心室射血分数、房室传导阻滞病史与CIED导线脱位事件风险增加独立相关。

• Objective To analyze the clinical risk factors of lead dislocation in cardiac implantable electronic devices (CIED). Methods A total of 78 patients with lead dislocation after CIED implantation due to arrhythmia from January 2013 to June 2024 in Beijing Anzhen Hospital, Capital Medical University were selected as the lead dislocation group. During the same period, 137 patients with arrhythmia who did not have lead dislocation after CIED implantation were randomly selected as the non-dislocation group. The baseline characteristics, laboratory test results and ultrasound results of the two groups were compared. Logistic regression was used to analyze the clinical risk factors of lead dislocation. Results The patients in the lead dislocation group were younger than those in the non-dislocation group ［(67±12)years vs (73±10)years］, and the proportion of patients with atrioventricular block and cardiac interventional procedure history was higher in the dislocation group than in the non-dislocation group ［46.2%(36/78) vs 10.9%(15/137), 23.1%(18/78) vs 7.3%(10/137)］(all P＜0.05). There were no significant differences in laboratory test results except alanine transaminase between the two groups (all P＞0.05). The left ventricular end-diastolic diameter and left ventricular end-systolic diameter in the lead dislocation group were larger than those in the non-dislocation group, and the left ventricular ejection fraction in the lead dislocation group was lower than that in the non-dislocation group (all P＜0.05). Multivariate binary Logistic regression analysis showed that higher left ventricular end-diastolic diameter (odds ratio=1.43), lower left ventricular ejection fraction (odds ratio=1.07) and history of atrioventricular block (odds ratio=16.74) were independently associated with increased risk of lead dislocation events (all P＜0.01). Conclusion Higher left ventricular end-diastolic diameter, lower left ventricular ejection fraction, and a history of atrioventricular block are independently associated with an increased risk of CIED lead dislocation events.