| Objective:We analyzed the cause of pacemaker system replacement and reset, and investigated the strategy for treatment, in order to reduce unnecessary operation, thus improve life quality and reduce economic cost of patients.Methods:The study was consecutively enrolled 1148 patients, who underwent permanent pacemaker implantation, replacement and reset, and retrospectively analyzed the cause and strategy for replacement and reset.Results:In the study,93 patients (8.10%) underwent pacemaker replacement and reset 100 times. The causes as follow:In the replacement group (69,6.01%):①Among 67 cases(5.84%) underwent pulse generator replacement,63 cases(5.83%) for energy exhaustion. Pacemaker Longevity of VVI and DDD was 10.25±2.69 and 8.85±1.9 years, respectively. In the VVI and DDD group, Ventricular threshold (RR=2.2; 1.6) and lead impendence (RR=0.6; 0.5) were main factors influence pacemaker longevity for patients.4 cases (3.48%) were pacemaker circuit dysfunction with pacemaker longevity for 1-3 years.②Among 22 cases(1.92%) underwent pacemaker lead replacement,20 cases (1.74%) were found to be parameter abnormal,2 cases (0.17%) occurred left infraclavicular lead fracture within 1-3 years after lead implantation. Discarded leads were cut, stump were embedded under subdermic region.3 cases (0.26%) and 1 cases (0.09%) have subclavical vein thrombosis and pulmonary embolism, respectively.In the reset group (31,2.70%):①15 cases (1.31%) had lead dislod-gement with 6 cases (0.52%) of atrial lead dislodgement,7 cases (0.61%) of ventricular dislodgement and 2 cases(0.17%) of both dislodgement.14 cases (1.21%) of lead dislodgement happened within 8 days after operation and 1 case (0.09%) within 60 days. All leads dislodgement were successfully replacement by means of lead reposition operation.②Among 16 cases(1.39%) who had pacemaker pocket infection and hemorrhage,10 cases(0.87%) were pocket hemorrhage and 6 cases(0.52%) were pocket infection without infective endocarditis or septicaemia. Patient with pocket hemorrhage were dealed with oppression. Hemorrhage was absorption in 4 cases (0.35%), others were recovery by ways of surgical hemorrhage cleaning operation. Pocket infectious patients could almost recovery by the treatment of combination of antibiotics and surgical pocket decollement, only 1 case(0.09%) underwent pocket infection repeatedly.Conclutions:1. The common reason for pacemaker replacement is energy exhaustion of pulse generator, pacemaker malfunction and lead fracture.2. Pacemaker threshold and lead impedance are main factors effected pacemakers longevity3. Clipping old leads and embedding fracture ends is the way to reimplanting new leads to deal with discarded lead. Deep venous thrombosis had high risk in this situation.4. Leads dislodgement especially early dislodgement (<6 weeks) are common in pacemaker system reset, but late lead dislodgement may happen either (>6 weeks).5. Pacemaker pocket infection and hematoma were main reasons for pacemaker system reset which is hard to deal with. If pocket oppression was not effective to treat pocket hematoma, hematoma cleaning operation may be further effective. It may be effective for pocket infection and erosion with combination of antibiotics and surgical pocket decollement operation, but relapse possiblely happen. |
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