双室同步起搏的临床应用及置入左室电极的初步体会

观察双室同步起搏治疗充血性心力衰竭 (CHF)的疗效 ,探讨左室电极置入的方法及注意事项。 10例患者均为原发性扩张型心肌病 (DCM)并CHF ,符合双室同步起搏治疗的指征。其中 8例置入Medtronic 2 187电极 ,1例置入Medtronic 2 188电极 ,1例置入右室主动固定电极。 9例左室电极置入成功 ,1例失败改行右室双部位起搏 ,术后患者左室舒张未径、左室射血分数及 6min步行距离均有改善 (术后 3个月与术前分别比较 :70 .8± 9.5vs 79.5± 12 .5mm ,0 .4 2± 0 .13vs 0 .2 5± 0 .10 ,384 .8± 4 5 .4vs 2 78.6± 34.5m ;P <0 .0 5或 0 .0 1)。借助电生理冠状静脉窦 (CS)标测电极、CS造影 (包括直接逆行CS造影和冠状动脉造影使CS间接显像 )对指导左室电极的置入有较大的价值。结论 :双室同步起搏治疗CHF疗效肯定 ,借助CS标测电极及CS造影可提高左室电极置入的成功率

Application of Biventricular Pacing and Preliminary Experience of Implanted Left Ventricular Lead.

To observe the efficacy of treating congestive heart failure (CHF) and to study the method and attention of implanting left ventricular(LV) Lead.10 dilated cardiomyopathy(DCM) patients with CHF and indications of biventricular pacing,were implanted with InSync 8040 pacemakers.8 patients were implanted with Medtronic 2187 lead,1 with Medtronic 2188 lead,1 with active right ventricular lead.9 patients were succeeded in implanting LV lead and 1 patient was accepted right ventricular bilocal pacing.Heart functions,left ventricular end diastolic diameter (LVEDD 70.8±9.5 vs 79.5±12.5 mm, P<0.05) ,LV ejection fraction(0.42±0.13 vs 0.25±0.10, P<0.01 ) and 6 minute hall walk distance(384.8±45.4 vs 278.6±34.5 m, P<0.001 ) were improved after pacing.Application of coronary sinus(CS) mapping lead and CS angiography made it easier to implant LV lead.Conclusion:Biventricular pacing is an effective way to deal with patients with CHF and application of CS mapping lead and CS angiography may raise the successful rate of implanting LV lead.