经永存左上腔静脉植入起搏电极体会

目的总结经永存左上腔静脉（PLSVC）植入起搏电极体会。方法总结4例PLSVC植入双腔起搏器的患者。患者出院前及出院后3个月、6个月进行随访，了解起搏器工作状态。结果4例患者术前均常规行经胸超声心动图检查，结果显示冠状静脉窦开口扩大，提示PLSVC存在可能。第1例患者因术前发现PLSVC可能，首先穿刺右侧锁骨下静脉；造影显示右上腔静脉缺如，右侧锁骨下静脉汇入PLSVC。第2、3例患者因双腔起搏器植入前反复出现心动过缓相关症状，在术前经右侧锁骨下静脉植人临时起搏器，术中造影显示PLSVC与右侧上腔静脉无交通。第4例患者在置入导丝时直接经PLSVC进入右心房。患者术后3个月、6个月常规行起搏器程控并调整起搏器出厂设置参数，此后每6—12个月行起搏器程控，程控时测量心房电极和心室电极的起搏阈值、感知和阻抗。均在满意范围。第1例患者两次随访时心律均为窦性心律，心房电极感知大于2mV，起搏阈值小于1V，阻抗小于1000Q。结论PLSVC能够顺利完成起搏电极植入。

Clinical experience of pacemaker lead implantation through persistent left superior vena cava

Objective To summarize the experience of pacemaker lead implantation through persistent left superior vena cava （PLSVC）. Methods To review and summarize the data of 4 cases in which pacemaker leads were implanted through persistent left superior vena cava. Results Among the 4 cases, 2 cases had temporary pacing through right subclavian rein due to synptomatic bradycardia. Transthorcic echocardiography was performed in all 4 cases and revealed a dilated coronary sinus indicating the existence of PLSVC. In case 1, PLSVC was found before surgery. The absence of right superior vena cava with drainage of right subclavian vein into PLSVC was confirmed under angiography. In case 2 and 3, temporany pacing were inserted through right subclavian vein and non-communicating PLSVC with right superior vena cava was found. In case 4, the guidewoire entered right atrium directhy through PLSVC. All the cases were followed up every 6 - 12 months with all the pace maker parameters lie within normal range. Conclusions Pacemaker lead can be implanted through persistent left superior vena cava smoothly.