110例心脏再同步化治疗中左室电极导线植入的临床经验和并发症分析

目的探讨心脏再同步化治疗(CRT)中左室电极的植入方法、特殊病情的个体化处理及并发症的预防。方法对110例心力衰竭患者行CRT。左室电极植入的方法:冠状静脉窦(CS)插管、CS及心脏静脉逆行造影(RCV)、选择靶静脉并植入电极。根据RCV静脉解剖特点选择靶静脉及特殊情况个体化处理。观察左室电极植入的成功率、左室电极的型号、置入CS靶静脉的部位、并发症。结果左室电极植入成功率为96.4%(106/110),4例左室电极未成功植入者包括1例植入DDD双腔起搏器、2例植入埋藏式心脏转复除颤器(ICD)及1例行心外膜左室电极植入术。9例特殊情况需个体化处理,其中2例心侧静脉狭窄应用球囊扩张数次,3例应用多根经皮球囊扩张冠状动脉成形术(PTCA)导丝加强支撑下植入左室电极,4例需更换不同型号或厂家的电极(包括3例术中和1例择期更换)。术中发生冠状静脉夹层或心肌穿孔5例(4.7%),仅1例择期CRT成功,另4例发生轻微夹层,少量或未见心包积液,但血流动力学稳定未影响左室电极置入。术中急性左室心力衰竭4例(3.7%),室性心动过速、心室颤动2例(1.9%),均经治疗未影响手术。结论左室电极植入有一定的风险和难度,采取个体化处理策略,可提高左室电极植入的成功率、并使并发症降至最低限度。

The application of left ventricular lead implantation and analysis of complications in 110 patients with cardiac resynchronization therapy

Objective To observe the clinical problems of left ventricular lead implantation during operation in cardiac resynchronization therapy （CRT）. Methods One hundred and ten patients received CRT were included in this study. The success rate of left ventricular lead, types of left ventricular lead, the location of left ventricular lead in CS and complications in these patients were observed. Results Left ventricular leads were successfully implanted in 106 cases （96. 4% ）, not successfully implanted in 4 （ DDD was implanted in 1, ICD in 2 and the left ventricle epicardial lead in 1 patient）. The prompt managements to the related problems of left ventricular leads were used in 9 cases （ vein balloon dilation was used in 2, multiple PTCA wires helped left ventricular lead implantation in 3, different left ventricular lead was changed in 4 during operation ）. Dissection and myocardial perforation happened in 5 patients （ the operation was delayed in 1 case and not influenced in 4 cases）. Acute left ventricular heart failure occurred in 4 cases, ventricular tachycardia and ventricular fibrillation in 2 cases. Conclusion The risks of left ventricular lead implantation relate with venous variants and serious heart disease, but it is important that the operators carefully operated and proper catheters are chosen. The appropriate management to its relative problems can decrease the complication of CRT operation.