探讨无导线起搏器术后股静脉血栓的发生及其临床特征。

连续入选2020年4月到2022年1月在复旦大学附属中山医院接受无导线起搏器植入的患者。所有患者均符合缓慢性心律失常植入单腔起搏器适应证。术后第1天复查股静脉穿刺处彩超，观察股静脉血栓的发生情况及其临床特征，并分析其相关因素。

研究纳入146例无导线起搏器植入术后患者，共4例（2.74%，4/146）患者出现股静脉血栓，年龄（75.75±19.14）岁，其中男3例，均无相关症状。经抗凝治疗后3例患者血栓在1个月后消失，1例在2个月后消失，未出现血栓栓塞等不良后果。股静脉血栓者D-二聚体水平（>0.5 mg/L）术前1例升高，术后3例升高，但术前和术后比较差异无统计学意义［0.33（0.26，0.94）mg/L对1.49（0.67，2.17）mg/L，P=0.057］。Spearman相关分析发现无导线起搏器术后股静脉血栓与术后D-二聚体升高呈显著正相关（r=0.239，P=0.037），而与年龄、性别、体重、合并症（心房颤动、高血压、糖尿病）、基线超声心动图参数、术前D-二聚体升高、X线曝光时间、伤口闭合方式等均无显著相关性（P均>0.05）。

无导线起搏器术后股静脉血栓发生率较低，无导线起搏器术后复查D-二聚体和穿刺点血管超声有助于及时发现股静脉血栓并及时开启抗凝治疗。

To investigate the incidence and clinical characteristics of femoral vein thrombus after leadless pacemaker implantation.

The patients received leadless pacemaker implantation in Zhongshan Hospital, Fudan University from April 2020 to January 2021 were consecutively included. All of the patients suffered from bradycardia were indicated for a single chamber pacemaker implantation and received femoral vein ultrasound at the first day post-procedure. The incidence and the clinical characteristics were described and the correlation factors were analyzed.

One hundred and forty-six patients were enrolled. The incidence of femoral vein thrombus was 2.74% (4/146). The average age of these 4 cases was (75.75±19.14) years old with 3 males,and all the patients were asymptomatic. During follow-up, there were no adverse outcomes happened, including thromboembolism with the thrombus. The femoral vein thrombus of 3 cases disappeared at 1 month's follow-up, and 1 case disappeared at 2 months post-procedure. In thrombus group, elevation of D-dimmer (>0.5 mg/L) were documented in 1 case (25.00%) pre-procedure, and 3 cases (75.00%) post-procedure while the median level of D-dimmer pre-procedure were not significantly different as compared to post-procedure [0.33(0.26,0.94) mg/L vs.1.49(0.67,2.17) mg/L,P=0.057)].The occurrence of femoral vein thrombus after leadless pacemaker implantation was significantly associated with D-dimmer elevation post-procedure by Spearman correlation analysis (r=0.239,P=0.037). While it was not significantly correlated to the other factors including age, gender, body weight, comorbidities (atrial fibrillation, hypertension and diabetes), baseline echocardiographic parameters, D-dimmer elevation pre-procedure, fluoroscopic time and closure methods (all P>0.05).

The incidence of femoral vein thrombus was rather low. Monitoring D-dimmer and performing puncture site ultrasound post-procedure are helpful to detect femoral vein thrombus and start anticoagulation in time.