左室主动固定电极在心脏再同步治疗中的初步应用  

Primary experience with an active fixation coronary sinus lead for cardiac resynchronization therapy

作　　者：周菁[1] 丁燕生[1] 李康[1] 盛琴慧[1] 蒋捷[1] 王禹川[1] 史力斌[1] 

机构地区：[1]北京大学第一医院心内科,100034

出　　处：《中国介入心脏病学杂志》2012年第2期87-89,共3页Chinese Journal of Interventional Cardiology

摘　　要：目的初步探讨左室主动固定电极在心脏再同步治疗(CRT)中的应用价值。方法选取5例符合心脏再同步治疗适应证的心力衰竭(心衰)患者,在常规CRT植入技术基础上,左室电极选用美敦力主动固定电极Attain Star Fix4195,到位后伸展伞叶将其固定至目标血管位置,测试参数并检测有无膈肌刺激,随访观察有无膈肌刺激、脱位、阈值明显增高及心功能改善情况。结果 5例心衰患者全部手术成功。靶目标血管分别为心侧静脉2例,心后侧静脉1例,心中静脉2例。起搏阈值为(1.3±0.7)V,R波幅度(7.9±2.9)mV。术后1周超声心动图与术前比较:左室舒张末内径(LVDd)由(7.43±0.87)cm下降为(7.15±0.76)cm,左室射血分数(LVEF)由(28.8±2.8)%上升为(36.0±4.0)%,肺动脉压(PAPs)由(51.0±20.6)mm Hg下降为(24.6±2.6)mm Hg,二尖瓣反流均有不同程度减轻。术后6～16个月随访:NYHA分级4例患者由Ⅲ级下降为Ⅱ级,1例患者由Ⅳ级下降为Ⅲ级,均无脱位和膈肌刺激出现。结论 CRT采用左室主动固定电极安全性好,降低脱位和膈肌刺激风险,增加手术成功率。Objective To investigate the experience with an active fixation coronary sinus lead for cardiac resynchronization therapy （ CRT） . Methods A total number of 5 patients were implanted with Medtronic StarFix active fixation LV lead for CRT. Based on standard CRT techniques,the active fixation coronary sinus leads were implanted to the target veins and the lobes were deployed for fixation. The thresholds were measured and no phrenic nerve stimulation were verified. Patients were followed up for the improvement of cardiac function and to check if there were any loss of capture,unacceptable pacing thresholds,or diaphragmatic stimulation. Results All the patients were successful for the use of the active fixation LV leads and were placed in a nonanterior position. Pacing threshold were averaged （ 1. 3 ± 0. 7） V, amplitude of R wave were （ 7. 9 ± 2. 9） mV in averaged. During follow up,LVDd was decreased from （ 7. 43 ± 0. 87） cm to （ 7. 15 ± 0. 76） cm,LVEF was increased from 28. 8% ± 2. 8% to 36. 0% ± 4. 0% ,PAPs decreased from （ 51. 0 ± 20. 6） mm Hg to （ 24. 6 ± 2. 6） mm Hg,mitral regurgitation decreased individually. After 6 - 16 months of follow up,all the cardiac functions were improved with one grade of reduction for the NYHA classification. No patient has any loss of capture,unacceptable pacing thresholds,or diaphragmatic stimulation. Conclusions The Medtronic 4195 is safe and highly efficacious. It affers more choices in lead placement location and has a remarkably reduction of dislodgement rate and diaphragmatic stimulation rate.

关 键 词：电生理学技术 心脏心力衰竭 电极 植入 

分 类 号：R514.6[医药卫生—内科学]