50例心脏再同步治疗并发症分析

目的 探讨心脏再同步治疗(CRT)术中、术后并发症死亡病例分析.方法 心力衰竭患者50例,男性32例,女性18例,年龄35～79(62.18±13.16)岁,其中扩张性心肌病35例,高血压性心脏病2例,缺血性心肌病10例,三度房室阻滞3例.心功能Ⅲ级(NYHA分级)37例、Ⅳ级13例.植入心脏再同步治疗系统(CRT,含CRT-D),平均随访(22.1±12.8)个月.结果 50例患者中49例成功植入心脏再同步治疗系统,成功率为98%.植入术中、术后相关并发症包括:冠状静脉窦夹层3例(6%),心脏静脉穿孔1例(2%),右心室穿孔1例(2%),膈肌跳动1例(2%);死亡4例,其中围手术期死亡2例.结论 CRT植入术有一定的风险,主要与左心室电极导线的植入过程有关,但亦可能与右心室电极导线相关.应掌握好适应证并作好充分的准备,规范操作,严密观察;同时规范随访和程控,以减少并发症的发生.

Complication analysis of cardiac resynchronization therapy in patients with congestive heart failure

Objective To analyze the complications of cardiac resynchronization therapy( CRT) in patients with congestive heart failure. Methods Fifty patients with congestive heart failure were chosen,32 male and 18 female,mean age(62. 18 ± 13. 16)years old. The etiologies of heart disease were dilated eardiomyopathy in 35 ,hypertension eardiomyopathy in 2,3rd AVB in 3 and ischemic myoeardiopathy in 10 ,with New York Heart association(NYHA) class Ⅲ ( n = 37 ) and Ⅳ ( n = 13 ). The patients received CRT implantation, with mean follow-up period(22. 1 ± 12. 8)months. Results Left ventricnlar lead was attempted to implant through coronary sinus for all the 50 patients and the success rate was 98%. Main complications included coronary sinus dissection in 3 patients,coronary vein perforation in 1 patients, right ventricle perforation in 1 patient, phrenic nerve stimulation in 1 patients ;4 patients died. Conclusions It is feasible and safe for implantation of CRT pacing system. However,there were some risk in the procedure. It is relative mainly to the implantation of the coronary sinus lead, but sometimes maybe relative to right ventricle lead. Doctors should take great attention to prevent complications during the implanting procedure and follow-up.