冠状动脉介入技术在经静脉左室电极植入中的应用价值  

Application value of percutaneous coronary intervention technology in transvenous left ventricular lead implantation

作　　者：齐书英[1] 高树军 李洁[1] 丁超[1] 王冬梅[1] 

机构地区：[1]白求恩国际和平医院心血管内科,河北石家庄050082 [2]空军西三庄干休所,河北石家庄050070

出　　处：《中国心脏起搏与心电生理杂志》2014年第2期119-122,共4页Chinese Journal of Cardiac Pacing and Electrophysiology

基　　金：河北省科技支撑计划项目(编号:11276124D)

摘　　要：目的探讨冠状动脉介入(PCI)技术在心脏再同步化治疗(CRT)左室电极导线植入术中的应用技巧和价值。方法心力衰竭拟行CRT植入患者178例,观察术中经冠状静脉途径植入左室电极导线的成功率、PCI技术应用情况、靶静脉选择及参数测定情况及随访结果。结果①CRT植入成功率97.75%(174/178),4例手术失败;经冠状静脉左室起搏电极导线植入成功率98.28%(171/174),3例行开胸心外膜电极植入。②左室起搏电极植入左室后静脉2例,心侧静脉89例,侧后静脉54例,心中静脉侧分支23例,心大静脉3例。③86例次使用了PCI技术(50.29%),其中10例(5.85%)应用鞘中鞘技术指引导丝到达靶静脉,双导丝技术38例(22.22%),导丝锚定技术15例(8.77%),逆向导丝技术12例(7.02%),球囊导管扩张冠状静脉中段11例(6.43%)。④术中左室起搏阈值(0.96±0.49)V,阻抗(677.06±215.93)Ω,R波振幅(16±3)mV,术后半年内左室电极起搏参数稳定。结论运用PCI技术可协助经冠状窦左室起搏电极的植入,并提高成功率。Objective To study and summarize the application and skills of percutaneous coronary intervention （PCI） in left ventrieular lead implantation in the treatment of patients with heart failure with cardiac resynchronization therapy （CRT）. Methods A total of 178 cases with chronic heart failure were prepared to receive CRT from 2005 to 2012 in two hospital, Success rate of left ventricular lead implantation through the coronary vein, application of PCI technology, target vein selection and parameter determination were observed. Results （1）Success rate of CRT plantation was 97.75% （174/178） and 4 cases failed;Success rate of left ventricular pacing lead implantation through coronary vein was 98.28% （171/174）, 3 patient was performed surgical epicardial lead placement due to abnormal coronary sinus. （2） Target vein selection of left ventricular pacing electrode according to the coronary sinus and results of cardiac vein angiography, 2 in posterior vein of left ventricle, 89 in lateral vein, 54 in lateral-posterior vein, 23 in middle cardiac vein, and 3 in great cardiac vein. （3） In the 171 cases of transvenous left ventrieular lead implantation, 10 cases using the sheath-in-sheath technology to guide wire reached the target vein, 38 cases using double-guide wire technique, 15 cases using wire anchor technique, 12 eases using retrograde wire technique, and 11 cases using balloon ductal dilatation technique to dilate the middle cardiac vein. （4） The left ventricular pacing threshold was （0.96± 0.49） V, impedance was （677.06±215.93） Ω, R wave amplitute was （ 16 ±3 ） mV, and postoperative parameters of left ventricular pacing electrode was stable within six months. Conclusions With flexible use of PCI technology and some skills of PCI, the success rate of left ventricular lead implantation through the coronary vein is significantly increased.

关 键 词：心血管病学 心脏再同步化治疗 左室电极 冠状静脉 经皮冠状动脉介入治疗 

分 类 号：R318.11[医药卫生—生物医学工程] R815[医药卫生—基础医学]