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

发布时间：2018-12-11 16:00

【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。
[Abstract]:Objective to summarize the method and clinical effect of cardiac resynchronization (CRT) by transatrial septal implantation of left ventricular endocardial electrode. Methods two patients with non-ischemic cardiomyopathy from March to August 2014 were treated with transatrial septal implantation of left ventricular endocardial electrode (CRT) in Xiangya Hospital of Central South University. Under local anesthesia, the atrial septum was punctured through the right femoral vein and the left subclavian vein was inserted into the left ventricle via the atrial septal puncture orifice. The left ventricular intimal pacing was performed by the left ventricular endocardial pacing. Through the query of Medline,EMBASE,CNKI,VIP and Wanfang database, the current status of this technology is summarized. Results one patient successfully implanted left ventricular endocardial pacing electrode to complete CRT. The patients were followed up for 9 months, the symptoms were obviously improved and no complications occurred. One patient was unable to complete CRT because the electrode could not pass through the puncture orifice after the puncture of atrial septum. Literature analysis showed that 101 patients underwent the operation through the superior / inferior vena mixes or only via the inferior / superior vena cava approach. The electrode was inserted into the left ventricle via the atrial septum by radiofrequency ablation with a large head electrode, a controllable crooked sheath, a trap or a three-dimensional heart mapping system, or the electrode was pulled out by establishing a track between the femoral vein and the superior vena cava. After operation, the cardiac function was improved in 2 cases, electrode dislocation in 2 cases and TIA;4 in 2 cases. Conclusion although the operation is difficult, for the patients who can not be treated with CRT through coronary sinus implantation of left ventricular pacing electrode, transatrial septal implantation of left ventricular endocardial electrode pacing with CRT is a good and safe method.
【作者单位】：中南大学湘雅医院心内科;南方医科大学珠江医院;
【分类号】：R541.7

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