117例双心室再同步起搏器植入术并发症分析

目的　双心室同步起搏已经被证明可有效改善充血性心力衰竭患者的心功能。进行双心室再同步治疗 (cardiacresynchronizationtherapy ,CRT)的技术关键是植入左心室导线。植入左心室导线技术难度大 ,操作复杂 ,有一定的并发症发生率 ,本文分析了 117例双心室起搏器植入术并发症。方法　充血性心力衰竭伴心室内阻滞患者 117例 ,其中男性 86例 ,女性 31例 ,平均年龄 (5 3 0 0±8 2 5 )岁。患者在进行逆行冠状静脉窦造影后 ,经冠状静脉窦插入导线至心脏静脉 (主要为心脏后静脉和侧后静脉 )进行左心室起搏。然后植入右心房和右心室电极导线。结果　 117例患者中 111例成功植入双心室起搏系统 ,成功率为 95 %。主要植入术的相关并发症包括 :冠状静脉窦夹层 4例(3 4 % % ) ,膈肌刺激需要重新植入 2例 (1 7% ) ;电极导线脱位 2例 (1 7% ) ,结论　双心室再同步治疗 (cardiacresynchronizationtherapywithbiventricularpacing)起搏器植入术有一定的术中并发症和一定的风险 ,术前应掌握好适应证并作好充分的准备 ,术中必须规范操作 ,严密观察 ,以减少并发症

Analysis of complications of biventricular pacemaker implantation in patients with congestive heart failure

Objective Previous studies have suggested that biventricular pacing could improve heart function in patients with congestive heart failure and intraventricular conduction delay.Implantation of left ventricular lead is a complicate procedure with potential of complications.This study is an analysis of complications of biventricular pacing in patients with congestive heart failure.Methods There were 117 patients,males in 86 and females in 31,mean age of 53 years old,with congestive heart failure and intraventricular conduction delay.Venography was performed in all patients.Different type of left ventricular lead was inserted to one of cardiac veins,especially posterior or lateroposterior cardiac vein,to pace left ventricle.Results 117 patients were attempted to implant left ventricular lead through coronary sinus.There were 111 successful implantations.The success rate was 95%.The complications include:coronary sinus dissection in 4 Patients,phrenic nerve stimulation required lead reposition in 2 patients and lead dislodgement in 2 patients. Conclusions It is feasible and safe to pace left ventricle through coronary sinus.However,there are complications related to the implantation procedure need to take attention.