经永存左上腔静脉植入起搏电极导线9例分析  

Experience and Long-term Results of Permanent Pacemaker Implantation Via Persistent Left Superior Vena Cava in 9 Cases

作　　者：顾敏[1] 华伟[1] 陈柯萍[1] 牛红霞[1] 陈旭华[1] 翟琳 胡奕然 张妮潇 刘曦[1] 张澍[1] GU Min;HUA Wei;CHEN Keping;NIU Hongxia;CHEN Xuhua;ZHAI lin;HU Yiran;ZHANG Nixiao;LIU Xi;ZHANG Shu(Center for Arrhythmia,National Center for Cardiovascular Diseases and Fuwai Hospital,CAMS and PUMC,Beijing(100037),China)

机构地区：[1]中国医学科学院/北京协和医学院/国家心血管病中心/阜外医院心律失常中心,北京市100037

出　　处：《中国循环杂志》2020年第8期771-776,共6页Chinese Circulation Journal

基　　金：中央高校基本科研业务费专项资金资助(3332019047)。

摘　　要：目的:回顾性分析经永存左上腔静脉植入起搏电极导线患者的临床资料,为临床医生提供参考。方法 :本研究入选了2009~2019年在中国医学科学院阜外医院经永存左上腔静脉植入起搏电极导线的患者9例,其中男性2例,女性7例,平均年龄为(47±25)岁。分析患者基线特征、导线类型、导线植入成功率、术中起搏参数等。术后3个月和6个月常规随访,以后每6~12个月随访。测试起搏阈值、感知及导线阻抗等参数,并随访观察并发症发生情况。结果 :9例患者中3例合并先天性心脏病,7例患者为孤立性永存左上腔静脉,2例为双上腔静脉,其中1例患者因右侧锁骨下静脉闭塞,被迫经左上腔静脉植入起搏导线,另1例患者因右锁骨下静脉留置深静脉管,选择经左上腔静脉植入起搏导线。术中2例病态窦房结综合征患者心室导线植入失败,选择植入心房单腔起搏器;1例病窦综合征患者心房导线植入失败,选择植入心室单腔起搏器。随访期间,1例患者于术后2周发现心室导线脱位,选择经右侧重新植入,其余患者未见并发症。随访中位时间1.8(1.1,4.3)年,随访期间心房、心室导线参数稳定。结论:经永存左上腔静脉植入心房、心室起搏电极导线均存在一定难度,短期内存在导线脱位风险,但远期导线参数稳定。双上腔静脉患者应避免经永存左上腔静脉植入导线。Objectives:To summarize the experience and long-term outcome of permanent pacemaker implantation via persistent left superior vena cava(PLSVC).Methods:A total of 9 patients undergoing permanent pacemaker implantation via PLSVC in Fuwai hospital from 2009 to 2019 were enrolled in this study.Baseline characteristics,lead types,implantation success rate and intraoperative pacing parameters were collected and analyzed.Pacing parameters and complications were observed during follow-up.Results:Of the 9 patients with PLSVC,3 were complicated with congenital heart disease and 7 were verified as the isolated persistent left superior vena cava.Ventricular lead implantation failed in 2 patients with sick sinus syndrome and patients received subsequent atrial single chamber pacemaker implantation.Atrial lead implantation failed in 1 patient with sick sinus syndrome and followed by ventricular single chamber pacemaker implantation.No complication was observed except a case of ventricular lead dislodgement occurring 2 weeks after the procedure and successful lead reposition was achieved thereafter.Both of the atrial and ventricular lead parameters were stable during the follow-up.Conclusions:Permanent pacemaker implantation via PLSVC is difficult and associated with the risk of lead dislodgement,but the long-term follow-up results are favorable.Permanent pacemaker implantation via PLSVC should be avoided in patients with bilateral superior vena cava.

关 键 词：永存左上腔静脉 起搏器 电极导线 脱位 

分 类 号：R541.4[医药卫生—心血管疾病]