经冠状窦心室起搏替代传统右心室起搏的可行性与安全性

目的 在普通心脏起搏器植入术中通过冠状窦(coronary sinus,CS)实施心室起搏,与传统右心室起搏比较其可行性与安全性.方法 具有心脏永久起搏器植入适应证的61例患者随机分为传统右室起搏组和经CS心室起搏组,比较2组手术成功率、并发症、QRS波时限及起搏器参数.结果 (1)经CS心室起搏组的手术即刻成功率低于传统右室起搏组(100%和68.97%,P<0.01);其中经CS心室起搏组采用左心室专用电极手术成功率明显高于普通心室翼状电极组(85.71%与25%,P<0.05);2组并发症发生率差异无统计学意义(P>0.05);(2)术后1月CS心室起搏组QRS波增宽的程度明显小于传统右心室起搏组(P<0.05);(3)经CS心室起搏组术中、术后1月、3月起搏阈值和电极阻抗虽高于传统右室起搏组(P<0.05),但其数值均在起搏参数允许范围内,起搏效果良好.结论 与传统右心室起搏比较,经CS心室起搏具有良好的安全性和有效性,更符合生理性心室激动顺序,采用左心室专用电极可明显提高CS心室起搏手术成功率.

Feasibility and Safety of Ventricular Pacing Through Coronary Sinus Comparing with Traditional Right Ventricular Pacing

Objective To study the feasibility and safety of coronary sinus(CS) ventricular pacing comparing with traditional right ventricular(RV) pacing in ordinary pacing treatment.Methods Sixty-one patients with an indication of pacemaker implantation were randomized into traditional RV pacing group and CS ventricular pacing group. The success rate,complications,preoperative and postoperative QRS wave duration and pacemaker parameters were compared between the two groups.Results(1) The instant success rate in traditional RV pacing and the CS pacing groups were 100% and 68.97%(P<0.01); the surgical success rate was significantly higher by using left ventricular electrode than the ventricle tined electrode in CS pacing group(85.71%and 25%,P<0.05). There was no significant difference in the incidence of complications between the two groups(P>0.05);(2) The increase of QRS complex width at postoperative 1 month in CS pacing group is significantly less than the RV pacing group(P<0.05);(3) Although the pacing threshold and electrode impedance during operation,postoperative 1 month and 3 months in CS pacing group were higher than RV pacing group(P<0.05),the CS pacing was effective.Conclusion The CS ventricular pacing is as safe and effective as traditional RVpacing,and is more consistent with physiological ventricular activation sequence.Using left ventricular electrode can significantly improve the success rate of CS ventricular pacing.