应用轨道法植入左室心内膜电极行心脏再同步化治疗
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摘要
目的总结心力衰竭(简称心衰)患者行轨道法植入心脏再同步化治疗(CRT)或CRT除颤器(CRT-D)左室心内膜电极方法及疗效。方法选取本院因无法行冠状静脉窦植入CRT/CRT-D左室心外膜电极的心衰患者6例,通过穿刺房间隔先后建立股静脉-房间隔-股动脉轨道和股动脉-房间隔-锁骨下静脉轨道,完成左室心内膜电极植入术,并比较手术前后心脏超声、心电图及心功能指标。结果 6例患者均成功通过轨道法植入CRT/CRT-D左室心内膜电极,术后1周随访QRS时限较前明显缩窄[(140.83±10.52)ms vs(166.83±13.60)ms,P<0.05],射血分数较前明显增加[(0.37±0.05)vs(0.27±0.04),P<0.05],心功能NYHA分级较前升高1～2级,患者心慌、胸闷等临床症状明显改善;术后1例发生左室电极穿孔,床边心脏超声示心包少量积液,予以左室电极重置后好转,其余无明显并发症。结论轨道法植入CRT/CRT-D左室心内膜电极安全、有效,是部分无法通过冠状窦植入心外膜电极的重要辅助术式。
Objective To summarize the method and effect of orbital implantation of cardiac resynchronization therapy(CRT)or CRT and cardioverter defibrillator(CRT-D)combined with implantation of left ventricular endometrium electrode in patients with heart failure(HF). Method Six patients with HF who were unable to perform implantation of CRT/CRT-D left ventricular epicardial electrode coronary venous sinus in our hospital were selected.Femoral vein-atrial septum-femoral artery orbit and femoral artery-atrial septum-subclavian vein orbit were established successively by puncturing atrial septum,and then complete left ventricular endocardial electrode implantation.Cardiac ultrasound,electrocardiogram and cardiac function were compared before and after surgery. Result All the 6 patients successfully implanted CRT/CRT-D left ventricular endocardial electrode by orbital method.QRS duration was significantly narrowed after 1 week follow-up[(140.83±10.52)ms vs(166.83±13.60)ms,P<0.05],and the ejection fraction was significantly increased[(0.37±0.05 vs(0.27±0.04),P<0.05].After surgery,one patient suffered from left ventricular electrode perforation.Bedside cardiac ultrasound showed a small amount of effusion in the pericardium,which was improved after resetting the left ventricular electrode. Conclusion Orbital method implantation of CRT/CRT-D left ventricular endocardial electrode is safe and effective.
Objective To summarize the method and effect of orbital implantation of cardiac resynchronization therapy(CRT)or CRT and cardioverter defibrillator(CRT-D)combined with implantation of left ventricular endometrium electrode in patients with heart failure(HF). Method Six patients with HF who were unable to perform implantation of CRT/CRT-D left ventricular epicardial electrode coronary venous sinus in our hospital were selected.Femoral vein-atrial septum-femoral artery orbit and femoral artery-atrial septum-subclavian vein orbit were established successively by puncturing atrial septum,and then complete left ventricular endocardial electrode implantation.Cardiac ultrasound,electrocardiogram and cardiac function were compared before and after surgery. Result All the 6 patients successfully implanted CRT/CRT-D left ventricular endocardial electrode by orbital method.QRS duration was significantly narrowed after 1 week follow-up[(140.83±10.52)ms vs(166.83±13.60)ms,P<0.05],and the ejection fraction was significantly increased[(0.37±0.05 vs(0.27±0.04),P<0.05].After surgery,one patient suffered from left ventricular electrode perforation.Bedside cardiac ultrasound showed a small amount of effusion in the pericardium,which was improved after resetting the left ventricular electrode. Conclusion Orbital method implantation of CRT/CRT-D left ventricular endocardial electrode is safe and effective.
引文
1谢启应,孙泽琳,杨天伦,等.经房间隔穿刺左心室心内膜起搏心脏再同步化治疗并文献分析[J].中国现代医学杂志,2015,25(9):88
2 Killu AM,Grupper A,Friedman PA,et al.Predictors and outcomes of"super-response"to cardiac resynchronization therapy[J].J Card Fail,2014,20(6):379
3中华医学会心血管病学分会,中华心血管病杂志编辑委员会.中国心力衰竭诊断和治疗指南2014[J].中华心血管病杂志,2014,42(2):98
4 Kutyifa V,Merkely B,Szilagyi S,et al.Usefulness of electroanatomical mapping during transseptal endocardial left ventricular lead implantation[J].Europace,2012,14(4):599
5 Elencwajg B,Lopez Cabanillas N,Cardinali EL,et al.The Jurdham procedure:endocardial left ventricular lead in-sertion via a femoral transseptal sheath for cardiac resynchronization therapy pectoral device implantation[J].Heart Rhythm,2012,9(11):1 798
6 Jais P,Takahashi A,Garrigue S,et al.Midterm follow up of endocardial biventricular pacing[J].Pacing Clin Electrophysiol,2000,(8):1 744
7 Pasquie JL,Massin F,Macia JC,et al.Long-term follow up of biventricular pacing using a totally endocardial approach in patients with end-stage cardiac failure[J].Pacing Clin Electrophysiol,2007,30(1):31
8 Ji S,Cesario DA,Swerdlow CD,et al.Left ventricular endocardial lead placement using a modified transseptal approach[J].JCardiovasc Electrophysiol,2004,15(2):234
9宿燕岗,聂振宁,秦胜梅,等.经房间隔穿刺行左心室内膜植入心脏再同步治疗除颤器1例[J].中华心律失常学杂志,2012,16(5):384
10 Ma Y,Li HC,Zheng LL,et al.Hemodynamic changes in depressive patients[J].J Zhejiang Univ Sci B,2006,7(2):133
2 Killu AM,Grupper A,Friedman PA,et al.Predictors and outcomes of"super-response"to cardiac resynchronization therapy[J].J Card Fail,2014,20(6):379
3中华医学会心血管病学分会,中华心血管病杂志编辑委员会.中国心力衰竭诊断和治疗指南2014[J].中华心血管病杂志,2014,42(2):98
4 Kutyifa V,Merkely B,Szilagyi S,et al.Usefulness of electroanatomical mapping during transseptal endocardial left ventricular lead implantation[J].Europace,2012,14(4):599
5 Elencwajg B,Lopez Cabanillas N,Cardinali EL,et al.The Jurdham procedure:endocardial left ventricular lead in-sertion via a femoral transseptal sheath for cardiac resynchronization therapy pectoral device implantation[J].Heart Rhythm,2012,9(11):1 798
6 Jais P,Takahashi A,Garrigue S,et al.Midterm follow up of endocardial biventricular pacing[J].Pacing Clin Electrophysiol,2000,(8):1 744
7 Pasquie JL,Massin F,Macia JC,et al.Long-term follow up of biventricular pacing using a totally endocardial approach in patients with end-stage cardiac failure[J].Pacing Clin Electrophysiol,2007,30(1):31
8 Ji S,Cesario DA,Swerdlow CD,et al.Left ventricular endocardial lead placement using a modified transseptal approach[J].JCardiovasc Electrophysiol,2004,15(2):234
9宿燕岗,聂振宁,秦胜梅,等.经房间隔穿刺行左心室内膜植入心脏再同步治疗除颤器1例[J].中华心律失常学杂志,2012,16(5):384
10 Ma Y,Li HC,Zheng LL,et al.Hemodynamic changes in depressive patients[J].J Zhejiang Univ Sci B,2006,7(2):133