冠状窦导线与三腔起搏  

Coronary sinus lead and triple chamber pacing

作　　者：王方正[1] 王锦志[1] 张奎俊[1] 明广华[1] 姚焰[1] 田瑞国[1] 朱克平[1] 陈新[1] 

机构地区：[1]中国医学科学院 中国协和医科大学 心血管病研究所 阜外心血管病医院,100037

出　　处：《中华心律失常学杂志》1998年第3期184-187,共4页Chinese Journal of Cardiac Arrhythmias

摘　　要：目的特殊设计的冠状静脉窦(冠状窦)导线用于三腔起搏,治疗病态窦房结综合征(病窦综合征)伴阵发性快速房性心律失常患者。方法三条电极导线(冠状窦、右房、右室)分别放置于冠状窦、右心房、右心室。双心房导线通过一个 Y 形接头和心室导线分别连接到 DDD 起搏器的心房和心室部分,行三腔起搏。结果 4例(男3例,女1例)患者冠状窦导线均置于其中段,右房导线3例置于右心耳,1例位于右房中外侧。右心室导线3例位于右室心尖部,1例位于右室中外侧。1例合并左上腔静脉畸形,右室导线通过冠状窦在右房绕一个圈进入右室心尖部。术中阈值测试,输出电压(V)、电流(MA)、阻抗(Ω)、PR 波振幅(mY)分别为冠状窦:0.56、0.76、744、4.4(P 波);右心房:0.56、1.2、467、6.3(P波);右心室:0.6、0.9、613、17.6(R 波),脉宽固定于0.5 ms。近期随访均呈 DDD 工作方式,起搏与感知功能良好,未发生房性快速心律失常,无并发症。结论特殊设计的冠状窦导线固定良好,三腔起搏性能可靠,方法可行,适用于房室阻滞或病窦综合征合并阵发性房性快速心律失常患者。Objective Use of a specifically designed coronary sinus(CS)lead for permanent triple chamber pacing to treat patients with sick sinus syndrom(SSS)with paroxysmal atrial tacbyarrthmias. Methods Three electrode leads(coronary sinus,right atrial and right ventricular leads)were positioned in the coronary sinus,right atrium(RA)and right ventricle(RV)separately,and were connected with DDD(R) pacemaker for triple chamber pacing.Results Three patients(two men and one woman)were successfully implanted DDD(R)pacemakers with tripe chamber pacing.The tip electrode of CS lead was eventually posi tioned in the mid-part of the CS in all patients.The tip elcetrode of right atrial lead was positioned in right atrial appendage in two patients,the other in right atrial mid-part.The tip electrode of RV lead was posi- tioned in right ventricular apex in two patients while the other was positioned in the mid-part of the right ventricular wall.The mean acute pacing threshold included voltage(V),current(mA),impedence(Ω)and P/R wave amplitude(mV)were measured on table,and the pacing mode was DDD.the pacing and sensing function of the pacemakers are excellent without complications in recent follow-up.Conclusion the results from this original experience of the new type of CS lead specifically designed for tripe chamber pacing are quite promising and stable,the ripe electrode can be successfully positioned in the middle part of the CS and acute pacing and sensing thresholds are good.So the triple chamber pacing can be used to treat patients with AV block and SSS with paraxysmal atrial tachyarrhythmias.

关 键 词：冠状窦 起搏 右心室 患者 房性快速心律失常 右室心尖部 右心房 阵发性 病窦综合征 并发症 

分 类 号：R541[医药卫生—心血管疾病] R654.2[医药卫生—内科学]