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ICD导线:阿喀琉斯之踵--访Harry Mond教授

作者:国际循环网   日期:2009/11/19 10:12:00

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植入式心律转复除颤器ICD的导线故障是这一技术的阿喀琉斯之踵,导线是ICD最可能出现故障的部分。从文献资料可以非常清楚地看到,ICD电极导线故障发生率相当高。最初故障发生是因为电极导线外周包被绝缘层的缺陷,但是最近我们意识到故障也可能发生于导体。我们用的绝缘材料是硅胶和聚氨酯,这两种材料都发现有一定的缺陷而且都不是最理想的。

 

  Harry Mond:As far as the conductors go, we have now introduced, instead of coils, cables, which are much stronger, smaller, and able to be made into much smaller leads. There is however a small incidence of cable fracture which remains essentially unexplained. Some of the incidences may be due to the way that doctors implant the lead, bending it at a critical point near the tip of the lead, which weakens the cable. We don’t have evidence at this point that this is actually so. It is all speculation. There is also confusion on what is the best way of welding or joining the cable to the anode ring, which is in the pace-sense lead where these fractures occur. We can either weld them or crimp them. Crimping means that we take a special coupler design where the cable goes into it. Then by crimping down on it, the actual anode cable was joined to the anode ring. There is some evidence to suggest that welding can cause breaks in the cable that could lead to fracture. I want to stress again that, although we see this under the microscope, we don’t have clinical evidence. We don’t have enough time, experience, or enough numbers to know exactly what the mechanism is.

  Harry Mond教授:从导体方面来看,我们现在已引入线缆以取代线圈,线缆强度更好,体积更小,能够做成更小的电极导线。但是,仍会发生线缆断裂,发生率很低,原因不明。部分原因可能归于医生植入电极导线的方法,因为如果在临近电极导线尖端的关键部位弯曲它,这可能使得线缆变弱。实际上我们没有这方面的证据,这只是一种推测。仍存在困惑的方面还有关于焊接或连接线缆到正极环的最佳方法。我们可以焊接或折叠,折叠意指我们在导体进入的地方选用一个特殊连接设计,然后折叠,这样正极线缆就与正极环连接了。有些证据表明,焊接可能导致线缆断裂

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