26例左心室主动固定导线应用的回顾性分析

目的评价左心室主动固定导线（Starfix^4195美国美敦力公司）在心脏再同步治疗（CRT）中的应用价值。方法分析自2010年7月至2012年8月在浙江大学医学院附属第二医院植入Starfix^4195导线的26例患者，男16例，女10例，平均年龄（68．1±7．7）岁，其中扩张型心肌病16例，缺血性心肌病5例，其他5例。观察Staffix^4195导线植入至最优起搏位点的手术成功率；术后中位随访10．5个月，观察出现左心室导线脱位、膈神经刺激及阈值升高等并发症的发生率。结果26例患者均成功植入Staffix^4195导线，手术成功率100％，24例患者（92．3％）左心室导线植入在最优起搏位点。CRT术后随访时间≥6个月的124例患者中，CRT有反应21例（87．5％），无反应3例（12．5％）。术后中位随访10．5个月，左心室导线起搏阈值稳定，与术中比较无明显增高（1．0±0．5）V对（1．2±0．7）V，P〉0．05]，术后均未出现左心室导线脱位、膈神经刺激等并发症。结论在CRT植入术中，Starfix^4195导线能稳定固定在左心室最优起搏位点，明显提高手术成功率，并显著减少术后并发症。

Retrospective analysis of application of left ventricular active fixation lead in 26 cases

Objective We evaluated the usage of an Deft ventricular （LV） active fixation lead （ Medtronic Attain Starfix4195 ） in cardiac resynchronization therapy（CRT） implantations. Methods Between July 2010 and August 2012,in 26 patients 16 male, 10 female, （ 68. 1±7.7） years, 16 dilated cardiomyopathy,5 ischemic cardiomyopathy, 5 others ] , the Starfix4195 lead was used.We observed success rate of implanting the N lead at the optimal pacing site,and after median follow-up of 10. 5 months,and the complications, e.g.lead dis- location,phrenic nerve stimulation and increasing pacing threshold were evaluated. Results Starfix419s lead im- plantation was overall successful with 100% ,in 24 cases the LV lead was implanted at the optimal pacing site. After a follow-up of over 6 months,21 cases（ 87. 5%）were responsive to C RT while another 3 cases （12. 5%） were nonresponse to CRT.After a median follow-up of 10. 5 months, the threshold of LV lead remained stable compared to that in surgery （ 1.0±0. 5 ） V vs. （ 1.2±0. 7） V, P〉 0. 05 ], and no dislocation of LV lead or phrenic nerve stimulation was observed. Conclusion The Starfix4195 lead proved to be an important option in CRT implantations, which can fix to the optimal pacing site steadily, thus significantly increasing surgery success rate as well as decreasing complications.