左心室四极导线心脏再同步治疗20例  

Quadripolar left ventricular lead in 20 cases with cardiac resynchronization therapy

作　　者：周颖[1] 徐晓红[2] 潘轶文 徐耕[1] 

机构地区：[1]浙江大学医学院附属第二医院心内科,杭州310009 [2]浙江医院心内科

出　　处：《中华心律失常学杂志》2016年第6期471-476,共6页Chinese Journal of Cardiac Arrhythmias

摘　　要：目的本文旨在评价左心室4极导线在心脏再同步治疗（CRT）中的应用价值。方法回顾性分析2014年3月至2015年4月在浙江大学医学院附属第二医院植入QuartetTM左心室4极导线的CRT患者．术中观察心脏静脉解剖特点、左心室导线植入部位及起搏向量选择：术后随访观察左心室导线的稳定性、阈值变化、膈神经刺激（PNS）及CRT反应性。结果共20例4极CRT患者。其中扩张型心肌病15例。缺血性心肌病3例，其他2例，平均年龄（65．6＋8．7）岁。20例患者均成功植入4极导线，其中19例首选靶血管1次植入成功。植入靶血管平均长度（71．5±15．2）mm。20例左心室起搏位点均位于左心室中间段／基底段（100％），其中12例头端电极（D1）固定于心尖段，7例D1植入左心室中段，1例D1固定于基底段、第4极（P4）未进入侧血管位于冠状静脉窦（CS）主干。19例导线头端嵌入小分支血管固定，1例无小分支供头端嵌入，术后1个月脱位。术中出现PNS7例、高阈值3例，均经程控调整起搏向量解决。术后中位随访6．7个月，头端电极、环状电极起搏阈值稳定（P〉0．05），术后左心室射血分数、心功能显著改善（P均〈0．05）。结论4极导线对于选择理想起搏阈值、避免心尖部起搏、减少PNS、增加左心室导线植入的成功率有较高的临床应用价值。该导线适合植入所有电极及s弯能全部进入、且导线头端有小分支嵌入的靶血管：短期随访QuartetTM左心室4极导线头端电极、环状电极起搏阈值稳定。Objective The purpose of this study was to evaluate the application value of new type of quadripolar left ventricular （LV） lead in patients received cardiac resynchronization therapy （CRT）. Methods Retrospective analysis was performed on heart failure patients following successful implantation of a quadripolar LV lead from March 2014 to April 2015 at The Second Affiliated Hospital ,Zhejiang University College of Medicine. Clinical data like the anatomy characteristics of coronary vein, location of LV lead and the selected pacing vector were collected intraoperatively. During follow-up, clinical data such as the stability of LV lead,pacing threshold, phrenic nerve stimulation （PNS） and CRT response were collected postoperatively. Results Totally 20 consecutive heart failure patients [ 15 dilated cardiomyopathy,3 ischemic cardiomyopathy, 2 others; mean age： （ 65.6 ± 8.7） years ] were selected in our study. All the 20 patients were implanted the quadripolar LV lead,in which 19 succeeded in the first target vein.The average length of LV lead target veins were（71.5±15.2） mm.The pacing sites of LV lead of the 20 cases were all at middle/basal segment（ 100% ）. Among them,the tip electrode （D1） of 12 cases were implanted at the apex of heart,7 at the middle segment and 1 at the basal segment with the proximal fourth electrode （P4） left in the coronary main vein.The tip of LV lead of 19 cases were implanted into small tributary, while in another one case ,target vein was lack of tributary, leading to the lead tip simply located in the distal end of lateral vein ,and one month later,LV lead was dislocated.During implantation, PNS was occurred in 7 cases and high pacing threshold in 3 cases, which were all overcome by reprogramming pacing vector.After a median follow-up of 6. 7 months, the threshold of tip electrode and ring electrode remained stable （ P〉 0. 05 ）, LVEF and NYHA improved significantly （ P〈 0. 05 ）. Conchmion The Quartet quadripolar LV lead proved to be better a

关 键 词：心脏再同步治疗 左心室4极导线 左心室起搏部位 并发症 

分 类 号：R541.7[医药卫生—心血管疾病]