右位心患者经静脉植入永久心脏起搏器13例分析  

Transvenous Permanent Pacemaker Implantation in 13 Patients With Dextrocardia

作　　者：顾敏[1] 华伟[1] 牛红霞[1] 陈旭华[1] 陈柯萍[1] 戴研[1] 樊晓寒[1] 刘志敏[1] 张澍[1] GU Min;HUA Wei;NIU Hongxia;CHEN Xuhua;CHEN Keping;DAI Yan;FAN Xiaohan;LIU Zhimin;ZHANG Shu(Arrhythmia Center,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》2021年第1期43-47,共5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:探讨右位心患者经静脉植入永久心脏起搏器的临床经验。方法:回顾分析了2008年3月到2019年2月在中国医学科学院阜外医院接受永久起搏器植入的13例右位心患者的临床资料。分析患者的基线特征、起搏器植入(包括起搏适应证、起搏模式、起搏参数和导线特征)、并发症以及术中参数和长期随访情况。结果:13例接受永久起搏器治疗的右位心患者平均年龄为(41.0±16.0)岁,其中男性3例(3/13)。6例(6/13)为单发右位心;7例(7/13)为镜面右位心。9例(9/13)患者合并其他先天性心脏病。6例(6/13)患者为房室阻滞;6例(6/13)患者为病态窦房结综合征;1例(1/13)患者为双结病变。所有患者术前均接受详细的超声心动图检查,4例(4/13)患者接受术前心脏增强CT检查。所有患者均成功完成永久起搏器植入,其中11例(11/13)植入双腔全自动型(DDD)起搏器,2例(2/13)植入单腔心室抑制型(VVI)起搏器。术中心房起搏阈值为(0.8±0.4)V/0.4 ms,P波(3.3±1.3)mV;心室起搏阈值为(0.6±0.2)V/0.4 ms,R波(11.0±3.8)mV。1例患者术后第2 d心房电极脱位,行电极调整术。其他患者未出现起搏并发症。平均随访(4.4±2.6)年(范围1~10年),患者起搏器参数良好,其中2例完成起搏器更换。结论:右位心患者解剖结构异常,植入起搏器存在一定的困难。术前详细超声心动图和心脏增强CT检查评价静脉系统解剖和房室连接关系有利于手术成功。右位心患者成功植入永久起搏器后中长期起搏参数稳定,预后良好。Objectives:Dextrocardia is a rare congenital anomaly.Transvenous pacing leads implantation can be challenging for patients with dextrocardia because of the distorted anatomy.Methods:Thirteen cases of patients with dextrocardia,who underwent pacemaker implantation in Fuwai hospital between March 2008 and February 2019,were included in this retrospective study.Baseline parameters were obtained and outcome data,including pacing characteristics,the complications associated with pacemaker implantation and long-term prognosis were analyzed.Results:The average age was(41.0±16.0)years,and 3(23.1%)were male.Of them,six were dextrocardia with situs solitus and seven were dextrocardia with situs inversus.Nine(69.2%)patients suffered from other congenital heart diseases.The indication for pacemaker implantation was atrioventricular(AV)block(n=6),sinus node dysfunction(n=6)and binodal disease(n=1).Transthoracic echocardiography were performed in all patients and preoperative augmented-reality computed tomography(CT)scan were performed in 4 patients to reveal the anatomy of venous system.Pacemaker implantation were successful in all patients(11 DDD pacemakers and 2 VVI pacemakers).The atrial and ventricular pacing threshold were(0.8±0.4)V/0.4 ms and(0.6±0.2)V/0.4 ms,respectively.The P wave and R wave amplitude were(3.3±1.3)mV and(11.0±3.8)mV,respectively.Atrial lead dislocation was found in one case and resolved by reposition with an active lead.A favorable outcome was noted during a mean follow-up o(f 4.4±2.6)years and two patients underwent pulse generators replacement during follow-up period.Conclusions:Permanent pacemaker implantation in patients with dextrocardia is feasible.Delineating the chamber anatomy and anatomic relationship by preoperative transthoracic echocardiography and CT scan are helpful for the successful pacing lead implantation.Pacing parameters are stable during the mid-term and long-term follow-up.Successful pacemaker implantation in dextrocardia patients is associated with a favorable mid-and lon

关 键 词：永久起搏器植入 房室阻滞 先天性心脏病 镜面右位心 单发右位心 

分 类 号：R541.4[医药卫生—心血管疾病]