左心室四极导线在心脏再同步治疗中的应用价值

发布时间：2018-05-03 06:14

本文选题：心脏再同步治疗 + 左室四极导线　；参考：《临床心血管病杂志》2017年06期

【摘要】：目的:本文旨在评价左室四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2014-01-2015-12在浙江大学医学院附属第二医院行CRT时植入美国圣犹达公司左室导线的患者46例,其中四极导线组22例,双极导线组24例,比较两组患者左室导线植入时间、植入部位、起搏向量选择等,术后随访6~12个月,比较两组术后膈神经刺激(PNS)、导线脱位等并发症发生率及CRT反应性等临床疗效。结果:两组患者的术前左室舒张末期内径(LVEDd)、左室射血分数(LVEF)和伴随疾病等差异均无统计学意义(P0.05)。四极组左室导线植入时间短于双极组,但差异无统计学意义[(60.0±33.5)min:(66.2±33.9)min,P0.05];四极组100%避免了心尖部起搏,双极组仍有4例(16.7%)左室导线起搏于心尖段(P0.05);术中四极组8例出现PNS,双极组出现5例,四极组仅1例更换靶血管,7例均通过调整起搏向量解决(P0.01),而双极组均更换靶血管。术后随访(13.4±4.1)个月,两组患者NYHA、LVEF均较术前显著改善(P0.05);与双极组相比,四极组术后6个月LVEF(42.1±6.6)%:(35.1±8.7)%,P0.05]、CRT反应性(81.8%:54.2%,P0.05)改善更显著。术后四极组4例出现PNS,均通过调整起搏向量解决,双极组2例出现PNS,通过降低输出和增加脉宽后解决。四极组1例术后1个月左室导线脱位。结论:左室四极导线在避免心尖部起搏、减少PNS、缩短CRT植入时间上具有明显优势,短期提高CRT反应性高于双极导线。
[Abstract]:Objective: to evaluate the value of left ventricular quadrupole traverse in cardiac resynchronization therapy (CRT). Methods: a retrospective analysis was made on 46 patients with left ventricular traverse implanted in the second affiliated Hospital of Zhejiang University School of Medicine from 2014-01-2015-12, including 22 cases in quadrupole traverse group and 24 cases in bipolar traverse group. The implantation time, site and pacing vector selection of left ventricular conductors were compared between the two groups. The postoperative follow-up was 6 ~ 12 months. The incidence of complications such as phrenic nerve stimulation, wire dislocation and CRT reactivity were compared between the two groups. Results: there was no significant difference in left ventricular end-diastolic diameter (LVEDD), left ventricular ejection fraction (LVEF) and associated diseases between the two groups (P 0.05). The left ventricular lead implantation time in the quadrupole group was shorter than that in the bipolar group, but the difference was not statistically significant [60.0 卤33.5)min:(66.2 卤33.9 min P 0.05]; 100% of the quadrupole group avoided the apical pacing, 4 cases of the bipolar group were still in the bipolar group) the left ventricular lead pacing occurred in the apical segment of the heart P0.05; in the quadrupole group, PNS was found in 8 cases, and in the bipolar group in 5 cases. In the quadrupole group, only one target vessel was replaced by adjusting the pacing vector in 7 cases, while the target vessel was replaced in the bipolar group. During the follow-up period of 13.4 卤4.1 months, the LVEF of NYHAN in both groups was significantly improved than that in the preoperative group (P 0.05), and in the quadrupole group the LVEF(42.1 卤6. 6%: 35. 1 卤8. 7% was significantly improved 6 months after operation compared with that in the bipolar group (P 0. 05), and the response to CRT was significantly improved in the quadrupole group (P < 0. 05, P < 0. 05, P < 0. 05, P < 0. 05, P 0. 05, P 0. 05, P < 0. 05). PNSs were found in 4 cases in the quadrupole group and in 2 cases in the bipolar group by adjusting the pacing vector, which were solved by decreasing the output and increasing the pulse width. One case in the quadrupole group had dislocation of left ventricular lead 1 month after operation. Conclusion: left ventricular quadrupole leads have obvious advantages in avoiding apical pacing, reducing PNS and shortening the time of CRT implantation. The short-term improvement of CRT reactivity is higher than that of bipolar conductors.
【作者单位】：浙江大学医学院附属第二医院心内科;武警浙江省总队医院心内科;浙江绿城心血管病医院心内科;浙江省中医院心内科;浙江医院心内科;浙江大学医学院附属邵逸夫医院心内科;
【分类号】：R541.6

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