经房间隔穿刺左心室内膜起搏心脏再同步化治疗并文献分析  

Transseptal endocardial left ventricular pacing for cardiac resynchronization therapy in patients with heart failure and literature review

作　　者：谢启应[1] 孙泽琳[1] 杨天伦[1] 杨平珍[2] 李传昶[1] 易军[1] 邓金华[1] 孟霜媛[1] 

机构地区：[1]中南大学湘雅医院心内科,湖南长沙410008 [2]南方医科大学珠江医院,广东广州510280

出　　处：《中国现代医学杂志》2015年第9期88-93,共6页China Journal of Modern Medicine

摘　　要：目的总结经穿刺房间隔植入左心室心内膜电极行心脏再同步化(CRT)治疗的方法和临床疗效。方法 2014年3-8月2例非缺血性心肌病患者在中南大学湘雅医院行穿房间隔植入左心室内膜电极CRT治疗。局部麻醉下经右股静脉穿刺房间隔,再经左锁骨下静脉经房间隔穿刺口送起搏导线入左心室行左室内膜起搏完成CRT植入术。通过查询Medline、EMBASE、CNKI、VIP和万方数据库等总结目前该技术开展的现状。结果1例患者成功植入左心室内膜起搏电极完成CRT术。随访9月,患者症状明显改善,无并发症发生。1例患者穿刺房间隔后因电极无法通过穿刺口而无法完成CRT术。文献分析示共101例患者通过上/下静脉混合法或单纯经下腔/上腔静脉途径穿刺房间隔实施该手术;采用射频消融大头电极、可控弯鞘、圈套器或心脏三维标测系统辅助将电极经房间隔送入左心室内;或经股静脉与上腔静脉建立轨道将电极拉出。患者术后心功能改善。2例患者早期出现电极脱位;2例出现TIA;4例出现囊袋积血。结论尽管操作难度大,对于无法经冠状静脉窦植入左心室起搏电极的CRT治疗的患者,经穿刺房间隔植入左心室心内膜电极起搏行CRT治疗是一种疗效较好、安全的方法。【Objective】To assess the feasibility and safety of a femoral transseptal endocardial left ventricular（LV） approach pacing for cardiac resynchronization therapy（CRT） in patients whose transvenous coronary sinus（CS）implantation had failed. 【Methods】Two patients with congestive heart failure who received a femoral transseptal endocardial LV approach pacing for cardiac resynchronization therapy（CRT） between March 2014 and August 2014 were enrolled. After puncture the atrial septum from the right femoral vein, an active fixation lead was implanted endocardially into the left ventricle via left subclavian vein. Literatures were collected by searching the databases of Pubmed, EMBASE, CNKI, VIP and Wanfang Data.【Results】The procedure was completed successfully in one case without complication. The symptoms and left ventricular eject fraction were improved during the 9-month fellow-up.One case failed to have the lead implantation because the lead could not be introduced into left atrium by passing through the puncture point in the atrial septum. Literatures showed previously a total of 101 cases received transseptal endocardial LV approach pacing by femoral combined superior vena cava or only via inferior or superior vena cava. Patients’ cardiac function was improved after the CRT. Only two cases failed for early dislocation of the electrodes. Four cases suffered from hemorrhage in pocket. Two cases had TIA during the fellow-up for anti-coagulation therapy was interrupted.【Conclusions】Cardiac resynchronization therapy with endocardial left ventricular pacing is a potential alternative to CS pacing and thoracotomy. Trials are needed to characterize long-term benefits and risks.

关 键 词：经房间隔 左心室内膜起搏 再同步化治疗 心力衰竭 

分 类 号：R541[医药卫生—心血管疾病]