心脏三腔起搏除颤器的临床应用

目的　评价具有心脏再同步化治疗 (CRT)和置入式心脏复律除颤器 (ICD)功能起搏器(CRT D)置入的安全性和有效性。方法　共 11例患者纳入研究。年龄 4 8～ 84 (71 6± 9 5 )岁 ,男 7例 ,女 4例。患者有心脏猝死或室性心动过速或电生理检查出现室性心动过速或心室颤动 ;左室射血分数≤ 35 % ,QRS≥ 12 0ms。所有患者置入的CRT D是美敦力INSYNCⅡMARQUIS 72 89,左心室电极置于冠状静脉窦左心室侧后壁分支或左后壁分支。右心房电极和右心室电极都使用主动螺旋电极 ,后者置于室间隔上部。手术在全麻下进行。术后次日在心脏超声指导下进行AV优化。结果　所有患者顺利度过手术 ,无并发症。放射时间为 19～ 73(44 7± 19 9)min。心房电极的振幅、阻抗和阈值分别为 (2 4 7± 0 77)mV、(5 90± 12 6 )Ω、(1 37± 0 71)V。右心室电极的振幅、阻抗和阈值分别为 (11 0 0± 3 4 8)mV、(5 86± 116 )Ω、(0 6 9± 0 2 1)V。左心室电极的振幅、阻抗和阈值分别为(15 37± 5 .15 )mV、(6 0 2± 12 5 )Ω、(1 6 2± 1 5 9)V。除颤阈 2 0J和 6J的各 3例 ,15J、12J和 3J各 1例。 1例患者因为原有除颤电极失效而更换为皮下电极 ,但仍除颤失败。另 1例患者因为出现心电图ST T变化而暂时未测定除颤阈值。所有患者除颤能量

Combined cardiac resynchronization and implantable cardioversion defibrillation

OBJECTIVE: To examine the efficacy and safety of implantation of the device with combined cardiac resynchronization therapy (CRT) and implantable cardioversion defibrillation (ICD) capabilities. METHODS: Eleven patients aged 48 - 80 (71.6 +/- 9.5) years, 7 male and 4 female, were included in the study. All patients had either a history of aborted sudden cardiac death, ventricular tachyarrhythmia, or induced ventricular tachycardia during cardiac electrophysiological study, whose left ventricular ejection fractions were 35% or less and QRS durations were 120 or longer. The patients were implanted a Medtronic INSYNC II MARQUIS(TH) 7289. All left ventricular leads were implanted in left lateral or left posterior lateral side-branches of coronary sinus. The procedures were performed in general anesthesia status. The AV interval was optimized guided by ECHO in all the patients in the day after the procedure. RESULTS: All procedures were successfully completed without major complications. The fluoroscopy time was 19 - 73 (44.7 +/- 19.9) min. Atrial lead amplitude, resistance and threshold were 0.5 - 3.5 (2.47 +/- 0.77) mV, 410 - 749 (590 +/- 126) Omega and 0.9 - 3.0 (1.37 +/- 0.71) V respectively. Right ventricular septal lead amplitude, resistance and threshold were 6.8 - 15.8 (11.00 +/- 3.48) mV, 387 - 750 (586 +/- 116) Omega and 0.4 - 1.0 (0.69 +/- 0.21) V respectively. The amplitude, resistance and threshold of left ventricular leads were 1.2 - 25 (15.37 +/- 5.15) mV, 423 - 812 (602 +/- 125) Omega and 0.3 - 5.0 (1.62 +/- 1.59) V respectively. The defibrillation thresholds (DFT) of 20 J were obtained in 3 patients, 6 J in 3 patients, and 15 J, 12 J and 3 J in one patient respectively. One of the 11 patients with failed old device did not obtain successful DFT after lead and device replacement and was defibrillated externally during DFT test. The another one did not obtain successful DFT because of abnormal ST-T changes in ECG. All devices were programmed to maximum of 30 J and discharged from the hospital in 48 hours except the one who failed to obtain DFT. The patients with mitral regurgitation improved after the AV optimization. CONCLUSIONS: Implantation of device with CRT and ICD features is safe even in aging patients. The long time outcomes of the clinical efficacy of this combined device remain to be observed.