19例左心室四極導(dǎo)線應(yīng)用的回顧性分析
發(fā)布時(shí)間：2018-09-17 17:37
【摘要】：目的：本文旨在評價(jià)左心室四極導(dǎo)線在心臟再同步治療(Cardiac Resynchronization Therapy,CRT)中的應(yīng)用價(jià)值。 方法：回顧性分析本院自2014年3月至2015年2月CRT術(shù)中成功植入QuartetTM左心室四極導(dǎo)線的心衰患者共19例,術(shù)中觀察：1)冠狀靜脈(CS)的造影情況及左室靶血管的選擇；2)術(shù)中導(dǎo)線固定不穩(wěn)定、膈神經(jīng)刺激或高閾值等并發(fā)癥的發(fā)生率；3)最終起搏向量的部位。術(shù)后隨訪1-12個(gè)月,觀察：1)術(shù)后心功能指標(biāo)如左室射血分?jǐn)?shù)(LVEF)、左室舒張末直徑(LVEDd)、QRS寬度、紐約心功能分級(NYHA分級)等；2)術(shù)后左室導(dǎo)線脫位、膈神經(jīng)刺激及閾值升高等并發(fā)癥的發(fā)生率。 結(jié)果：本文入選19例心衰患者,其中擴(kuò)張型心肌病14例,缺血性心肌病3例,其他2例,男性12例,女性7例,平均年齡65.9±8.8歲。冠狀靜脈的血管條件符合QuartetTM左心室四極導(dǎo)線植入要求的19例患者均成功植入該四極導(dǎo)線,手術(shù)成功率100%。19例患者的最終左室起搏向量均位于左室中間段/基底段,其中16例患者(84.2%)左室電極放置在最優(yōu)起搏位點(diǎn)。18例患者首選靶血管一次植入成功,術(shù)中出現(xiàn)膈神經(jīng)刺激7例、閾值不理想2例,均通過程控調(diào)整起搏向量后解決。1例患者因首選靶血管全部起搏向量均出現(xiàn)膈神經(jīng)刺激或起搏高閾值,需要通過更換靶血管解決。術(shù)后中位隨訪6個(gè)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寬度[(118.7±9.8)vs (159.5±20.6) ms, p0.05]、NYHA分級[(2.3±0.5)vs(3.2±0.5)級,p0.05]均較術(shù)前改善明顯；左室電極起搏閾值穩(wěn)定[(1.2土0.7)vs(1.1±0.6)V,p0.05]。19例患者術(shù)后中位隨訪6月,1例患者(5.3%)在術(shù)后1月出現(xiàn)左室導(dǎo)線脫位,其余患者未出現(xiàn)導(dǎo)線脫位、膈神經(jīng)刺激或左室起搏閾值增高等術(shù)后并發(fā)癥。 結(jié)論：左心室四極導(dǎo)線對于冠狀靜脈血管條件符合植入要求的CRT患者能最大程度解決起搏閾值高、膈神經(jīng)刺激等導(dǎo)線并發(fā)癥,提高手術(shù)成功率,同時(shí)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 鹵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 鹵8.6) vs (29.8 鹵4.5), p0.05] LVEDd [(63.9 鹵10.7) vs (68.3 鹵6.8) mm, p0.05] were significantly improved [(118.7 鹵9.8) vs (159.5 鹵20.6) ms, p0.05] and (2.3 鹵0.5) vs (3.2 鹵0.5) before operation. The left ventricular electrode pacing threshold was stable [(1.2 鹵0.7) vs (1.1 鹵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.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R541.6
本文編號：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 鹵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 鹵8.6) vs (29.8 鹵4.5), p0.05] LVEDd [(63.9 鹵10.7) vs (68.3 鹵6.8) mm, p0.05] were significantly improved [(118.7 鹵9.8) vs (159.5 鹵20.6) ms, p0.05] and (2.3 鹵0.5) vs (3.2 鹵0.5) before operation. The left ventricular electrode pacing threshold was stable [(1.2 鹵0.7) vs (1.1 鹵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.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R541.6
【參考文獻(xiàn)】
相關(guān)期刊論文 前2條
1 金煒;孟衛(wèi)棟;汪芳;張建軍;孫寶貴;劉少穩(wěn);;左室電極起搏位置與心臟再同步化治療的療效[J];中國心臟起搏與心電生理雜志;2011年04期
2 趙琳;于波;;左室不同起搏部位對心臟再同步化治療短期療效的影響[J];中國心臟起搏與心電生理雜志;2012年01期
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