19例左心室四极导线应用的回顾性分析
发布时间：2018-09-17 17:37
【摘要】：目的：本文旨在评价左心室四极导线在心脏再同步治疗(Cardiac Resynchronization Therapy,CRT)中的应用价值。 方法：回顾性分析本院自2014年3月至2015年2月CRT术中成功植入QuartetTM左心室四极导线的心衰患者共19例,术中观察：1)冠状静脉(CS)的造影情况及左室靶血管的选择；2)术中导线固定不稳定、膈神经刺激或高阈值等并发症的发生率；3)最终起搏向量的部位。术后随访1-12个月,观察：1)术后心功能指标如左室射血分数(LVEF)、左室舒张末直径(LVEDd)、QRS宽度、纽约心功能分级(NYHA分级)等；2)术后左室导线脱位、膈神经刺激及阈值升高等并发症的发生率。 结果：本文入选19例心衰患者,其中扩张型心肌病14例,缺血性心肌病3例,其他2例,男性12例,女性7例,平均年龄65.9±8.8岁。冠状静脉的血管条件符合QuartetTM左心室四极导线植入要求的19例患者均成功植入该四极导线,手术成功率100%。19例患者的最终左室起搏向量均位于左室中间段/基底段,其中16例患者(84.2%)左室电极放置在最优起搏位点。18例患者首选靶血管一次植入成功,术中出现膈神经刺激7例、阈值不理想2例,均通过程控调整起搏向量后解决。1例患者因首选靶血管全部起搏向量均出现膈神经刺激或起搏高阈值,需要通过更换靶血管解决。术后中位随访6个月,19例患者LVEF[(38.7±8.6)vs (29.8±4.5)%, p0.05]、LVEDd[(63.9±10.7)vs(68.3±6.8)mm, p0.05]、QRS宽度[(118.7±9.8)vs (159.5±20.6) ms, p0.05]、NYHA分级[(2.3±0.5)vs(3.2±0.5)级,p0.05]均较术前改善明显；左室电极起搏阈值稳定[(1.2土0.7)vs(1.1±0.6)V,p0.05]。19例患者术后中位随访6月,1例患者(5.3%)在术后1月出现左室导线脱位,其余患者未出现导线脱位、膈神经刺激或左室起搏阈值增高等术后并发症。 结论：左心室四极导线对于冠状静脉血管条件符合植入要求的CRT患者能最大程度解决起搏阈值高、膈神经刺激等导线并发症,提高手术成功率,同时避免左室心尖部起搏,改善心功能。
[Abstract]:Objective: to evaluate the value of left ventricular quadrupole conductors in cardiac resynchronization therapy (Cardiac Resynchronization Therapy,CRT). Methods: from March 2014 to February 2015, 19 patients with heart failure who were successfully implanted with QuartetTM left ventricular quadrupole lead during CRT operation were retrospectively analyzed. The angiographic findings of coronary vein (CS) and the choice of target vessels of left ventricle were observed during the operation. 2) the incidence of complications such as unstable wire fixation, phrenic nerve stimulation or high threshold during operation (3) the site of the final pacing vector. All patients were followed up for 1-12 months. The cardiac function parameters such as left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDd) QRS width, New York cardiac function grade (NYHA grade) and so on were observed. Incidence of complications such as phrenic nerve stimulation and elevated threshold. Results: there were 19 patients with heart failure, including 14 patients with dilated cardiomyopathy, 3 patients with ischemic cardiomyopathy, 2 patients with other heart failure, 12 males and 7 females with an average age of 65.9 卤8.8 years. All the 19 patients with coronary vein who met the requirement of QuartetTM left ventricular quadrupole traverse implantation were successfully implanted. The final left ventricular pacing vectors of 100. 19 patients were located in the middle / basal segment of the left ventricle. Among them, 16 patients (84.2%) had left ventricular electrode placement at the optimal pacing site. 18 patients had successful implantation of the first target vessel, 7 patients had phrenic nerve stimulation and 2 patients had unsatisfactory threshold. After the pacing vector was adjusted by program control, the phrenic nerve stimulation or the high threshold of pacing were found in all the pacing vectors of the first selected target vessels, which needed to be solved by replacing the target vessels. After 6 months of median follow-up, LVEF [(38.7 卤8.6) vs (29.8 卤4.5), p0.05] LVEDd [(63.9 卤10.7) vs (68.3 卤6.8) mm, p0.05] were significantly improved [(118.7 卤9.8) vs (159.5 卤20.6) ms, p0.05] and (2.3 卤0.5) vs (3.2 卤0.5) before operation. The left ventricular electrode pacing threshold was stable [(1.2 卤0.7) vs (1.1 卤0.6) VP 0.05]. 19 patients were followed up for 6 months. One patient (5.3%) had dislocation of the left ventricular lead at one month after operation, while the other patients had no dislocation of lead, phrenic nerve stimulation or increased threshold of left ventricular pacing. Conclusion: left ventricular quadrupole conductors can solve the complications of high pacing threshold, phrenic nerve stimulation and other traverse complications in CRT patients with coronary vein vascular condition, and improve the success rate of operation, while avoiding left ventricular apex pacing. Improve cardiac function.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R541.6
本文编号：2246636
[Abstract]:Objective: to evaluate the value of left ventricular quadrupole conductors in cardiac resynchronization therapy (Cardiac Resynchronization Therapy,CRT). Methods: from March 2014 to February 2015, 19 patients with heart failure who were successfully implanted with QuartetTM left ventricular quadrupole lead during CRT operation were retrospectively analyzed. The angiographic findings of coronary vein (CS) and the choice of target vessels of left ventricle were observed during the operation. 2) the incidence of complications such as unstable wire fixation, phrenic nerve stimulation or high threshold during operation (3) the site of the final pacing vector. All patients were followed up for 1-12 months. The cardiac function parameters such as left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDd) QRS width, New York cardiac function grade (NYHA grade) and so on were observed. Incidence of complications such as phrenic nerve stimulation and elevated threshold. Results: there were 19 patients with heart failure, including 14 patients with dilated cardiomyopathy, 3 patients with ischemic cardiomyopathy, 2 patients with other heart failure, 12 males and 7 females with an average age of 65.9 卤8.8 years. All the 19 patients with coronary vein who met the requirement of QuartetTM left ventricular quadrupole traverse implantation were successfully implanted. The final left ventricular pacing vectors of 100. 19 patients were located in the middle / basal segment of the left ventricle. Among them, 16 patients (84.2%) had left ventricular electrode placement at the optimal pacing site. 18 patients had successful implantation of the first target vessel, 7 patients had phrenic nerve stimulation and 2 patients had unsatisfactory threshold. After the pacing vector was adjusted by program control, the phrenic nerve stimulation or the high threshold of pacing were found in all the pacing vectors of the first selected target vessels, which needed to be solved by replacing the target vessels. After 6 months of median follow-up, LVEF [(38.7 卤8.6) vs (29.8 卤4.5), p0.05] LVEDd [(63.9 卤10.7) vs (68.3 卤6.8) mm, p0.05] were significantly improved [(118.7 卤9.8) vs (159.5 卤20.6) ms, p0.05] and (2.3 卤0.5) vs (3.2 卤0.5) before operation. The left ventricular electrode pacing threshold was stable [(1.2 卤0.7) vs (1.1 卤0.6) VP 0.05]. 19 patients were followed up for 6 months. One patient (5.3%) had dislocation of the left ventricular lead at one month after operation, while the other patients had no dislocation of lead, phrenic nerve stimulation or increased threshold of left ventricular pacing. Conclusion: left ventricular quadrupole conductors can solve the complications of high pacing threshold, phrenic nerve stimulation and other traverse complications in CRT patients with coronary vein vascular condition, and improve the success rate of operation, while avoiding left ventricular apex pacing. Improve cardiac function.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R541.6
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相关期刊论文 前2条
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2 赵琳;于波;;左室不同起搏部位对心脏再同步化治疗短期疗效的影响[J];中国心脏起搏与心电生理杂志;2012年01期
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