冠状窦电极的临床应用研究

目的　评价 sp2 188电极及普通心室电极经冠状窦行左心房起搏的可行性和安全性。方法　 16例患者 ,其中 9例选用 sp2 188电极 ,7例选用普通心室电极。所有患者均行左锁骨下静脉穿刺 ,X线采用正位或左前斜位植入冠状窦电极 ,寻找最佳的起搏和感知部位 ,同时高能量也不致心室夺获。结果　 15例患者成功植入于冠状窦中、远端 ,术中起搏参数如下 (单极 ,脉宽 0 .5 4 m s) ,sp2 188电极组 :电压 ( 1.4 5± 1.4 5 ) V,感知 ( 4 .2 6± 0 .77) m V,阻抗 ( 5 0 5 .6±10 8.1) Ω;普通心室电极组 :电压 ( 1.4 3± 0 .91) V,感知 ( 3.93± 1.4 4 ) m V,阻抗 ( 4 6 8.3± 14 5 .1) Ω。两组起搏电压、感知、阻抗差异无显著性 ( P值均 >0 .0 5 )。随访 2～ 32 (平均 15 .0 )月 ,无一例死亡。其中 2例 sp2 188电极者发生脱位及微脱位 ,各有 1例 sp2 188电极者及普通心室电极发生起搏器介导性心动过速。最后一次随访结束 ,两组患者冠状窦电极起搏和感知功能均良好。结论　普通心室电极经冠状窦中、远端行左心房起搏可行、安全 ,且价格便宜 ,适合临床应用。

Clinic application of coronary sinus lead

Objective To evaluate the feasibility and safety of sp2188 lead and ordinary ventricle lead performing left atrium pacing through coronary sinus. Methods Sp2188 leads were used in nine patients and ordinary ventricle leads in seven patients. Under fluoroscopy in frontal or left anterior oblique projection, coronary sinus leads were positioned via left subclavian venous route in all the patients. Optimal pacing and sensing sites were searched. Meanwhile, high energy was discharged which failed to capture the ventricle. Results Coronary sinus leads were positioned successfully in the middle or distal part of the coronary sinus in fifteen patients. At implantation, the acute pacing threshold (unipolar, pulse width 0.54ms) in sp2188 leads was 1.45±1.45V. The sensitivity was 4.26±0.77mV. The lead impedance was 505.6±108.1Ω. the acute pacing threshold (unipolar, pulse width 0.54ms) in ordinary ventricle leads was 1.43±0.91V. The sensitivity was 3.93±1.44mV. The lead impedance was 468.3±145.1Ω. There were no statistical significant in the pacing threshold, sensitivity and lead impedance in two groups (all P>0.05). During 15.0±12.4(2～32) months follow-up, there was no death. Dislocation and slight dislocation of sp2188 leads happened in two patients, and pacemaker mediated tachycardias appeared in one patient respectively. The pacing and sensing function of coronary sinus leads was good in two groups at the end of follow-up. Conclusion The ordinary ventricle lead, which is cheap, is feasible and safe for left atrium pacing through the middle and distal part of the coronary sinus and suitable for clinical application.