一种新型Visionwire标测导丝在心脏再同步化治疗中的应用

目的探讨一种新型Visionwire标测导丝在心脏再同步化治疗(CRT)左室电极植入过程中的应用价值。方法 5例因心力衰竭接受CRT的患者,分别采用Visionwire导丝及左室电极到达可植入左室电极的冠状静脉(CS)分支内进行起搏参数测试及电生理标测,比较两种方法的起搏参数测试、电生理标测结果及手术时间。结果在5例患者的16个CS分支中,两种方法所测的起搏参数值无显著性差异,二者的起搏阈值有强相关性(r=0.90,P<0.01),感知亦有相关性(r=0.67,P<0.01),二者最大起搏电压引起膈肌刺激的部位相似。应用Visionwire导丝可以进行局部电位电激动顺序标测。Visionwire导丝对单个CS分支进行起搏参数测定比应用左室电极进行起搏参数测定所需时间明显缩短(12.4±7.5 min vs 18.3±12.2 min,P<0.01)。结论应用Visionwire标测导丝可以预测CS分支的左室电极起搏参数,根据局部电位延迟可准确定位左室电极植入部位。

Application of a novel pacing guide wire in cardiac resynchronization therapy

Objective To investigate the availability of a novel Visionwire guide wire in the implantation of left ventricular(LV) lead in cardiac resynchronization therapy(CRT).Methods Five heart failure patients selected for CRT were involved in the study.The pacing threshold,R-wave sensing,phrenic nerve stimulation at local coronary sinus(CS) branch were measured by the Visionwire guide wire and LV lead separately.Results The pacing parameters were analysed through the Visionwire guide wire and LV lead separately at the 16 CS branches in 5 patients.There were no significant difference between the pacing parameters measured by the two methods.Significant correlation was found between LV pacing threshold assessed by the Visionwire guide wire and LV lead(r=0.90,P<0.01).Correlation for R wave sensing was also significant(r=0.67,P<0.01).The pacing sites accompanied with phrenic nerve stimulation while pacing at 10 V/0.42 ms were similar by the two methods.Visionwire guide wire could be used for local potential electrical mapping.The procedure time for pacing test in a single CS branch by Visionwire guide wire was much less than that by LV lead(12.4±7.5 min vs 18.3±12.2 min,P<0.01).Conclusions Visionwire guide wire facilitates transvenous LV lead implantation by prediction of pacing parameter and locate the target CS branch quickly.