2020 年第 1 期 第 15 卷

全身兼容磁共振成像心脏再同步化治疗及埋藏式心脏自动除颤器植入的安全性研究

Clinical safety of cardiac resynchronization therapy and implantable cardiac defibrillator implantation compatible with magnetic resonance imaging

作者：李巧元1项美香2宿燕岗3戴文龙1何东方1方冬平1郭成军1

英文作者：

单位：1首都医科大学附属北京安贞医院心内六科100029；2浙江大学医学院附属第二医院心内科，杭州310009；3复旦大学附属中山医院心内科，上海200032

英文单位：

关键词：磁共振成像；心脏再同步化治疗及埋藏式心脏自动除颤器；兼容磁共振成像心脏起搏器

英文关键词：

• 摘要：

• 【摘要】目的    观察植入兼容磁共振成像（MRI）心脏再同步化治疗及埋藏式心脏自动除颤器（CRT-D）围术期以及术后MRI检查的安全性。方法    2017年12月至2018年3月选取药物控制欠佳的心力衰竭患者12例，植入兼容MRI的CRT-D（Inventra 7 HF-T QP），观察植入时、植入后1个月、MRI检查前后、MRI检查后1个月及3个月起搏器参数等情况。结果    12例植入CRT-D患者中男7例、女5例，10例（83.3%）患者进行了MRI检查，CRT-D植入时、植入后1个月、MRI检查前、MRI检查后、MRI检查后1个月及3个月电学参数差异均无统计学意义（均P>0.05）。MRI检查后1个月与MRI检查前相比，右心房阻抗的变化为（51±31）Ω，左心室阻抗的变化为（116±90）Ω，右心室阻抗的变化为（26±4）Ω，除颤阻抗的变化为（5.6±2.1）Ω。其中3例存在伪影，但不影响阅片诊断，1例心脏区伪影严重影响阅片；所有患者均未见起搏阈值增高、感知异常及导线移位、心肌穿孔等情况。结论    兼容MRI的CRT-D植入是安全可行的，植入后能安全进行MRI扫描。

• 【Abstract】Objective    To observe the safety of magnetic resonance imaging(MRI)-conditional cardiac resynchronization therapy, implantable cardiac defibrillator(CRT-D) implantation and postoperative MRI performance. Methods    From December 2017 to March 2018, 12 heart failure patients with poor response to medication therapy were implanted MRI-conditional CRT-D（Inventra 7 HF-T QP）. Pacemaker parameters were observed during implantation, 1 month after operation, before MRI scanning and 1, 3 months after MRI examination. Results    There were 7 males and 5 females. MRI was performed in 10 cases（83.3%）. There were no significant changes of CRT-D electrical parameters during implantation, 1 month after operation, before and 1, 3 months after MRI scanning（all P>0.05）. The variations of electrical parameters at 1 month after MRI were （51±31）Ω for right atrial impedance, （116±90）Ω for left ventricular impedance, （26±4）Ω for right ventricular impedance and （5.6±2.1）Ω for defibrillation impedance. Three cases showed slight artifacts in MRI which did not affect diagnosis, while 1 case had severe artifact around the heart that hindered image reading. No threshold increasing, sensation abnormality and lead dislodgment, myocardium perforation were observed. Conclusion    MRI-conditional CRT-D pacemaker is feasible and MRI scanning can be performed safely after implantation.