Variación esperable de parámetros medidos en el implante y seguimiento de electrodos de fijación activa de marcapasos definitivos / Foreseeable variation in parameters measured at implant and follow-up of permanent pacemaker active fixation electrodes

Objetivos: Analizar la variación de parámetros relativos al electrodo de fijación activa en el implante y seguimiento posterior durante 6 meses de fase aguda de implante. Diseño: Estudio descriptivo, analítico, prospectivo, observacional sobre cohorte de casos sucesivos durante 8 meses (abril-diciembre de 2010). Ámbito: Unidad de electro-estimulación cardiaca de un Servicio de Medicina Intensiva. Pacientes o participantes: Pacientes sometidos a implante de marcapasos definitivo con electrodos de fijación activa, implantados en aurícula y ventrículo, Intervenciones: medición de variables descritas con analizador de umbrales durante la fijación de electrodo y en los diferentes momentos del estudio, Variables principales que se comparan; umbral, impedancia y actividad intrínseca tanto auricular como ventricular antes y después de la fijación del electrodo, a las 48h, al mes y 6 meses de seguimiento, Se realizaron comparaciones utilizando test T-student para datos pareados; con significación si p<0,05 y un test ANOVA para analizar los cambios sucesivos del seguimiento ambulatorio. Resultados: Se analizan 40 pacientes, 19 electrodos auriculares y 40 ventriculares, En la fijación del electrodo varía de forma significativa la impedancia del electrodo auricular (1,188,53±397,26 vs 610,69±326,30 ohmnios, p<0,0001) y ventricular (1,512,93±718,07 vs 768,80±224,90 ohmnios, p>0,0001), A las 48h se suma una disminución del umbral de (..) (AU)

Objectives: To analyze the variations in the parameters relative to active fixation electrodes at the time of implantation and over subsequent follow-up during 6 months of the acute phase of implantation. Design: A descriptive, analytical, prospective, observational cohort study was made of consecutive cases over a period of 8 months (April-December 2010). Setting: Pacing unit of an Intensive Care Unit. Patients or participants: Patients undergoing permanent pacemaker implantation with active fixation electrodes, implanted in both atrium and ventricle, Interventions: Measurement of variables described with a threshold analyzer during electrode fixation and at different times during the study, Main compared variables: threshold, impedance and intrinsic activity (both atrial and ventricular) before and after fixation, at 48hours, at one month and 6 months, Comparisons were made using the Student t-test for paired data, assuming significance for p<0,05, and ANOVA to analyze the successive changes over ambulatory follow-up. Results: We analyzed 40 patients, with 19 atrial and 40 ventricular electrodes, In fixation, the electrodes showed significant variation in the impedance (..) (AU)

[Foreseeable variation in parameters measured at implant and follow-up of permanent pacemaker active fixation electrodes]. / Variación esperable de parámetros medidos en el implante y seguimiento de electrodos de fijación activa de marcapasos definitivos.

OBJECTIVES: To analyze the variations in the parameters relative to active fixation electrodes at the time of implantation and over subsequent follow-up during 6 months of the acute phase of implantation. DESIGN: A descriptive, analytical, prospective, observational cohort study was made of consecutive cases over a period of 8 months (April-December 2010). SETTING: Pacing unit of an Intensive Care Unit. PATIENTS OR PARTICIPANTS: Patients undergoing permanent pacemaker implantation with active fixation electrodes, implanted in both atrium and ventricle, Interventions: Measurement of variables described with a threshold analyzer during electrode fixation and at different times during the study, Main compared variables: threshold, impedance and intrinsic activity (both atrial and ventricular) before and after fixation, at 48 hours, at one month and 6 months, Comparisons were made using the Student t-test for paired data, assuming significance for p<0,05, and ANOVA to analyze the successive changes over ambulatory follow-up. RESULTS: We analyzed 40 patients, with 19 atrial and 40 ventricular electrodes, In fixation, the electrodes showed significant variation in the impedance values of the atrial lead (1,188,53 ± 397,26 vs 610,69 ± 326,30 ohms, p<0,0001) and ventricular lead (1,512,93 ± 718,07 vs 768,80 ± 224,90 ohms, p>0,0001), In the first 48 hours it was coupled with a decrease in ventricular (0,86 ± 0,35 vs 0,48 ± 0,23 volts, p = 0,0001) and atrial pacing threshold (1,10 ± 0,39 vs 0,43 ± 0,23 volts, p = 0,0003), and p-wave sensing (3,61 ± 2,25 vs 2,32 ± 1,09 mV, p = 0,0463), Over follow-up we found the parameters to be stable, with no significant changes. CONCLUSIONS: After active lead fixation, a fall in impedance of the antrial and ventricular is expected, Over the next 48 hours improvement in atrial and ventricular threshold may occur, in contrast to the sensitivity of the intrinsic activity, which reached significance at the P wave measured after 48 hours, These values stabilize over patient follow-up and do not differ significantly in the studied acute patient course.