2187导线在左心室起搏中的应用价值

目的寻找左心室电极导线的导入途经和技术要点及其在双心室起搏中的临床实用价值.方法 9例病人,男性8例,均为药物治疗无效合并CLBBB的顽固性心力衰竭.CS造影7例采用逆行法,2例采用顺行法显示CS.选择可剥脱CS导引导管和左室电极导线(Medtronic,2187),采用左锁骨下静脉穿刺法,经CS将电极导线置于CS左心室属支,起搏左心室.结果无论是逆行还是顺行冠状动脉造影,均清晰显示CS及其属支静脉.6例病人经导引导管将2187导线成功导入靶静脉,3例病人直接导入2187导线.电极导线尖端1例插进心大静脉远端,2例位于左室侧缘静脉,2例放在左室后静脉, 4例导入左室后侧静脉.导线到位后测量的各起搏参数均符合起搏要求,长期随访未见导线脱位和起搏功能的变化.结论 CS顺行和逆行造影均可清晰显示CS及其属支;直接或经导引导管皆可将2187电极导线导入靶静脉;应用2187型LV电极导线经CS左心室心外膜起搏技术可行、安全可靠,可广泛临床应用.

Initial results with left ventricular pacemaker lead implantation using a 2187 left ventricular pacing lead

Objective The aim was to investigate the manupulation and the localization of LV Lead, and to evaluate LV Lead usefulness in biventricular pacing.Methods 9 Patients with enlarged left ventricle, chronic heart failure, CLBBB and refractory to chemical therapy were selected in this study, including 8 males and 1 female. Coronary sinus venography was performed by injecting contrast medium retrogradely at coronary sinus ostium in 7 cases or antegradely into left coronary artery in 2 cases. LV lead was introduced to CS and localized at targeting vein of LV through a "peel away" guiding sheath, which was placed in CS via left subclavian vein route. Results Coronary sinus and its tributaris were clearly visualized by both antegrate cardiac venography and retrograte cardiac venography. 2187 leads were implanted into targeting veins through "peel away" guiding sheaths in 6 cases and directly introduced in 2 cases, while in other case the lead was inserted into coronary sinus directly after a failed procedure via a "peel away" guiding sheath. The leads were placed in great cardiac vein in 1 case, lateral LV vein in 2 cases, left posterior LV vein in 2 case and left posterolateral veins in 4 cases. The acute pacing and sensing thresholds measuered during the implanting procedure were in normal limits. 2187 leads were still fully functional without dislocalization during follow up of average 253 days. Conclusion CS and its tributaries can be clearly shown by antegrate and retrograte venographies. The introduction of 2187 left ventricular pacing is easily performed directly or through a preformed "peel away" guiding sheath. LV epicardium pacing by 2187 LV lead implanted through CS is feasible and reliable.