心外膜电极导线在心脏再同步左室起搏中的应用(附二例报道)

目的报道2例心外膜电极导线在心脏再同步治疗(CRT)左室起搏中的应用及结果。方法2例均因心脏靶静脉解剖结构问题不能经心脏静脉途径置入左室电极,其中1例为右室双部位(心尖部+流出道间隔)起搏3个月后无效的患者。全麻后气管插管,在左第4肋间腋前线处切口,进胸后切开心包,用缝线将心外膜电极固定于左室侧后下壁,通过皮瓣下隧道把左室电极送入囊袋并与脉冲发生起搏器左室孔相联。结果2例手术顺利,无并发症。术后左室同步性明显好转,射血分数增加,心功能改善。结论心外膜导线在CRT左室起搏中的应用是安全、可行的,术后短期随访可获得良好的临床疗效。

Application of epicardial lead for left ventricle pacing in cardiac resynchronization therapy

Objective To report the application of epicardial lead for left ventricle pacing in cardiac resynchronization therapy (CRT). Methods The left ventricle lead was not embedded into the heart vein in the two patients with congestive heart failure due to anatomical feature of the target vein. One patient was implanted epicaridial lead after the operation in catheter room directly, and the other received epicaridial lead after 3 months with bifocal right ventricular (apical and high septum of outflow tract) pacing, in which the heart function didn’t improve. Under the general anesthesia and tracheal intubation, the pericardium was incised after entering thoracic cavity from the incision of the fourth left intercostals thoracotomy. Epicardial lead (Medtronic 4965) was sutured on the posterior-lateral region of the left ventricle and connected to the pulse generator in the sac through subcutaneous tunnel. Results The operation was successful without any complications. The synchronism of inter-ventricles and intra-left ventricle was improved and rejection fraction was enhanced significantly. Conclusions Application of epicardial lead for left ventricle pacing is feasible and safe in CRT. Favorable clinical outcome can be acquired after follow-up for several months.