普通电极导线行右房左室或双心室起搏的初步临床观察

探讨普通电极导线置入心脏静脉起搏左室的可行性。选择 9例患者为研究对象 ,其中扩张型心肌病 3例、缺血性心脏病 3例、其他 3例 ,均伴不同程度的心力衰竭 ,心功能Ⅱ～Ⅳ级。所有患者都安置DDD起搏器。窦性心律伴房室阻滞 (AVB)或完全性左束支阻滞 (CLBBB)患者 ,行右房左室顺序起搏 ;房颤患者行双心室起搏。左心室起搏是将普通右心室导线 (MedtronicCapSureSP 4 0 2 3)通过冠状窦送入心脏静脉施行的。结果 :7例成功 ,2例失败。导线定位在左室后静脉 1例、后侧静脉 3例、侧静脉 3例。术中测左室起搏阈电压、阻抗和R波振幅分别是 0 .7± 0 .2V、6 2 3± 6 6Ω、10 .1± 6 .0mV。术后 2～ 18个月阈电压、阻抗分别是 0 .5± 0V、5 2 1± 5 1Ω。术后 1～ 2周平均心功能从2 .9级改善到 1.9级 ,平均心胸比值从 0 .6 1缩小到 0 .5 7,平均左室射血分数从 0 .39升至 0 .4 4。随访期未发现左室导线脱位 ,膈肌起搏等并发症。结论 :普通电极导线置入心脏静脉长期起搏左心室是可行的、牢靠的。

Original Clinical Observation of Permanent Right Atrial Left Ventricular or Biventricular Pacing Using Conventional Lead.

t To observe the feasibility and stability of permanent left ventricular (LV)pacing using conventional ventricular lead positioned in a cardiac vein.9 patients with dilated cardiomyopathy or ischemic heart disease and with congestive heart failure and atrioventricular block(AVB) or left bundle branh block(LBBB),were studied.DDD pacemaker(Medtronic Sigma SD 203)for right atrial and left ventricular(LV) pacing were implanted in the patient with sinus rthymia and AVB or LBBB,and biventricular pacing in the patient with atrial fibrillation,which LV pacing were performed by using conventional lead(Medtronic CapSure SP 4023) positioned in a cardiac vein through coronary sinus.Results:Permanent LV pacing were successful achieved using conventional lead positioned in a cardiac vein in 7 patients and failure in 2 patients.The place where lead located were 1 left posterior vein,3 post lateral branch veins and 3 lateral veins.Threshold voltage,impedance and R wave amplitude were 0.7±0.2 V,623±66 Ω,10.1±6.0 mV during operation,and Threshold voltage,impedance were 0.5±0 V,521±51 Ω during follow up respectively.NYHA class of cardiac function mean from 2.9 to 1.9,X ray show cardiac chest ratio mean from 0.61 to 0.57,LVEF mean from 0.39 to 0.44.There are no lead related complication during 2～18 months follow up.Conclusion:Permanent left ventricular pacing using conventional lead placed in a cardiac vein are feasible and stable.