三维标测指导下经房间隔动静脉轨道法植入左心室心内膜电极的应用  

Feasibility and Efficacy of Endocardial Left Ventricular Lead Implantation Through Trans-atrial Septal Approach Using Arteriovenous Track Technique Under the 3D Mapping Guidance

作　　者：姜程[1] 胡浩[1] 许广莉[1] 吴强[1] 马佳良 林欣[1] 李嘉正 王琼英[1] 白锋[1] 张淑文 张静[2] 徐姣姣 JIANG Cheng;HU Hao;XU Guang-li;WU Qiang;MA Jia-liang;LIN Xin;LI Jia-zheng;WANG Qiong-ying;BAI Feng;ZHANG Shu-wen;ZHANG Jing;XU Jiao-jiao(Department of Cardiology,Lanzhou University Second Hospital,Lanzhou (730030),Gansu,China)

机构地区：[1]兰州大学第二医院心内科,甘肃省兰州市730030 [2]兰州大学第二临床医学院

出　　处：《中国循环杂志》2018年第12期1233-1236,共4页Chinese Circulation Journal

基　　金：兰州市人才创新创业项目(2016-RC-54;2016-RC-104)

摘　　要：目的:探讨三维标测指导下经房间隔动静脉轨道法植入左心室心内膜电极技术的可行性及疗效。方法:对2例因冠状静脉畸形或无良好的心外膜靶血管,而无法行常规心脏再同步化治疗(CRT)植入的扩张型心肌病患者,在三维心内膜标测指导下找出左心室最晚激动点,采用房间隔穿刺方法,建立左锁骨下静脉-左心室-股动脉轨道,植入左心室心内膜电极。结果:2例患者术后1月临床症状均逐渐改善,纽约心脏协会(NYHA)心功能分级从术前Ⅳ级改善至Ⅱ级;6分钟步行试验距离由术前的112 m、145 m提高至术后的860 m、530 m;左心室射血分数(LVEF)由术前的26%、20%提高至术后的35%、28%;二尖瓣反流束最大面积由术前的10.6 cm^2、6.4 cm^2降至术后7.4 cm2、5.5 cm^2。优化程控起搏器后,QRS波宽度分别由术前的150 ms、174 ms,降至116 ms、110 ms。结论:三维心内膜标测指导下经房间隔动静脉轨道法植入左心室心内膜电极技术可行,且可以减少电极植入的盲目性,提高术后应答。Objectives: To explore the feasibility and efficacy of left ventricular endocardial electrode leads implantation under the 3 D electroanatomic mapping guidance through the trans-atrial septal approach using the arteriovenous track technique. Methods: Two DCM patients with malformation of coronary vein or unsuitable epicardial target vessel for the routine leads implantation of CRT were included in this report. 3 D electroanatomic mapping systems was used to find the lasted excitation point of left ventricle, left subclavian vein-left ventricle-femoral artery track was established to implant the left ventricular endocardial electrode through trans-atrial septum approach.Results: The left ventricular leads were successfully implanted in these two patients through above mentioned technique. At onemonth after the procedure, the New York Heart Association(NYHA) functional class was improved from class Ⅳ to Ⅱ. The distance of six-minute walk test of these two patients increased from 112 m/145 m to 860 m/530 m, respectively and the left ventricular ejection fraction(LVEF) increased from 26%/20% to 35%/28%, respectively, the maximum area of mitral regurgitation reduced from 10.6 cm2/6.4 cm^2 to 7.4 cm2/5.5 cm^2, respectively. The QRS duration reduced from 150 ms/174 ms to 116 ms/110 ms, respectively after optimizing the pacemaker program. Conclusions: The implantation of left ventricular endocardial electrode leads, guided by 3 D mapping through trans-atrial septal approach with arteriovenous track is feasible and the guiding by 3 D electroanatomic mapping systems can reduce the blindness in the implantation of the left ventricular electrode and improve the response to CRT therapy.

关 键 词：三维心内膜标测 动静脉轨道法 心脏再同步化治疗 左心室心内膜电极 

分 类 号：R54[医药卫生—心血管疾病]