Circulation:起搏器再利用安全可行

　　墨西哥学者的一项研究表明，在伴有缓慢性心律失常的患者中，起搏器再利用为安全可行的备选方案。论文于2013年2月20日在线发表于《循环》（Circulation）。

　　在发展中国家中，一些患者因经济问题而延迟置入起搏器。此项研究共纳入603例序贯性患者；接受重新消毒起搏器和新起搏器置入的患者分别为307例和296例。复合终点由三项主要转归组成，其中包括意外电池耗竭、感染和器械故障。

　　结果显示，再利用组和对照组的起搏器取出率分别为17.6%和10.5%（RR为1.68，P= 0.02）。共有43例患者达到主要终点，再利用组和对照组分别为27例（7.2%）和16例（5.5%）（RR为1.3，P = 0.794）。再消毒和新起搏器的意外电池耗竭率分别为3.6%和1.7%（RR为2.12，P = 0.116)，操作相关性性感染率分别为3.2%和3.7%（RR 0.87，P= 0.46），再利用组出线1例器械故障。

Re-Use of Pacemakers: Comparison of Acute and Long Term Performances

Background—In developing economies, there are patients in which pacemaker (PM) implantation is delayed because they cannot afford one. Reused devices have been a solution. To address concerns regarding safety, a cohort of consecutive patients implanted with a reused PM was compared with a control group.

Methods and Results—A cohort of 603 consecutive patients from 2000 to 2010 was studied in an ambispective non-inferiority study. The study group (n = 307) received a re-sterilized PM and the control group (n = 296) a new PM. A combined endpoint of three major outcomes was analyzed: Unexpected battery depletion, infection, and device dysfunction. A total of 85 PM had to be explanted 31 (10.5%) in the control group vs. 54 (17.6%) in the study group (RR 1.68, CI 95% 1.1 - 2.5; P= 0.02). Forty-three reach the primary endpoint, 16 (5.5%) in the control group vs 27(7.2%) in the study group (RR: 1.3; CI 95% 0.70 - 2.45; P = 0.794). Individual outcomes: (1) Unexpected battery depletion: 5 (1.7%) new PM vs 11 (3.6%) re-sterilized PM (RR 2.12, CI 95% 0.75 - 6; P = 0.116); (2) procedure-related infection: 3.7% in new PM vs 3.2% (RR 0.87, IC 95%: 0.38 - 2.03; P= 0.46); (3) malfunction: one case was encountered in the study group.

Conclusions—PM reuse is feasible and safe and a viable option for patient with bradyarrhythmias. Other than for the expected lower battery life, reuse of pacemaker generators is not-inferior to the use of new devices.