- 期刊
無導線的心臟節律器（Leadless Pacemaker）的臨床應用
Clinical Practice of Leadless Pacemaker
摘要
傳統上經靜脈放置的永久性心臟節律器，是透過一個或數個放置在心臟內的電極導線(electrode lead)，及一個放置在皮下的節律產生器(pulse generator)來給心臟適當的電生理刺激，使病人能有適當的心跳和心臟收縮。雖然這些手術技術目前已經相當安全、成熟，但是因著設計上一些先天的限制，這些永久性心臟節律器還是有可能產生某些術中或術後的併發症，如氣胸、局部感染等。近幾年隨著科技的進步，有兩種新型的無導線心臟節律器(Nanostim^®, Micra^®)被發明出來，給心臟科醫師和病人們一個新的選擇。它沒有導線、不需要在胸前的皮下做一個口袋來放置節律器，因此它們排除了因經靜脈導線或皮下口袋所導致併發症的可能性，而且也讓整個手術變得更簡單、快速。在此，我們回顧相關文獻，整理目 前這種新型心臟節律器的臨床證據，及使用上的優缺點。同時，也分享我們的案例。
並列摘要
Conventional transvenous permanent pacemaker is implanted via a pulse generator at subcutaneous pocket and put one or multiple pacing leads in the heart. It can provide adequate electrophysiological stimulus to generate adequate heartbeat for the patients. Although the technique of these procedures is quite mature and safe, there are still some peri-procedural and long-term complications owing to their inherent limitations by original design, such as pneumothorax or local infection...etc. Recently, two kinds of novel leadless pacemakers (Nanostim^®, Micra^®) have been invented and give cardiologists an alternative choice to treat the patients. They don’t need pacing leads, or a subcutaneous pocket to place a pulse generator. So they eliminate the potential transvenous lead- and pacemaker pocket-related complications, and make the procedure become much easier and faster. Herein, we review the relevant literatures, current evidence, and the advantages and disadvantages of the leadless pacemakers. In addition, we share our patient who experienced the complications of conventional pacemaker, and successfully implanted the novel leadless pacemaker.