左室双部位心室三位点起搏心脏再同步化治疗  

Clinical effects of bi-left ventricle lead for triple-site ventricular pacing in patients with congestive heart failure

作　　者：谢启应[1] 孙泽琳[1] 杨天伦[1] 蒲晓群[1] 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

出　　处：《中国心脏起搏与心电生理杂志》2015年第4期295-298,共4页Chinese Journal of Cardiac Pacing and Electrophysiology

摘　　要：目的介绍左室双电极行心室三部位起搏心脏再同步化治疗射血分数(EF)值降低心力衰竭的的经验和临床疗效。方法 2012年8月至2014年7月共有3例心房颤动伴完全性左束支传导阻滞的女性患者,因EF值降低心力衰竭植入左室双电极行心室三部位起搏心脏再同步化治疗。局麻下采用微创介入方法,在钢丝导引下送一根左室电极至心大静脉或侧静脉;另送一根左室电极至侧静脉或后静脉;再送心室电极入右室心尖部,分别连接脉冲发生器的心房、左室和右室孔。结果 3例患者均手术成功,术中起搏参数满意,无并发症发生。随访2,12,24个月,1例患者出现导线移位和起搏阈值增高,患者心功能恶化。其他2例患者心功能明显改善,超声提示心脏缩小,左室EF升高,起搏器参数理想。结论对于EF降低心力衰竭伴永久性心房颤动、有心脏再同步治疗指征的患者,经皮左室双电极行心室三部位起搏心脏再同步化治疗是安全、疗效较好的方法。Objective Conventional cardiac resynchronization therapy（CRT） with a single right ventricular and a sin- gle left ventricular lead is associated with lower-response up to 30% of patients. Triple-site ventricular pacing may show some advantages compared to conventional method. We sought to identify the method and long effects of bi-left ventricle lead for triple-site ventricular pacing in patients with congestive heart failure. Methods Three patients with congestive heart failure who received triple-site ventricular pacing during 2012 Aug and 2014 Jul were enrolled. A CRT device con- nected to 1 RV and 2 LV leads, inserted in 2 separate coronary sinus tributaries, was successfully implanted. The right ventricular and one left ventricular leads were implanted for a conventional Bi-V system, an additional left ventricular lead was inserted into the atrial hole of the pulser for Tri-V. Results Pacemakers were implanted successfully in all cases without complications. The symptoms and left ventricular eject fraction were improved during the 24 and 12 month follow-up respectively. Except one case suffered worse during the follow-up and two left ventricular lead can not work well for dis- lodgement. Conclusion CRT with triple-site pacing that 1 RV and 2 LV leads is safe and associated with significantly LV reverse remodeling.

关 键 词：心血管病学 左室双部位 心室三位点起搏 心力衰竭 再同步化治疗 

分 类 号：R318.11[医药卫生—生物医学工程] R541.61[医药卫生—基础医学]