右位心患者经静脉植入永久心脏起搏器13例分析

目的:探讨右位心患者经静脉植入永久心脏起搏器的临床经验.方法:回顾分析了2008年3月到2019年2月在中国医学科学院阜外医院接受永久起搏器植入的13例右位心患者的临床资料.分析患者的基线特征、起搏器植入(包括起搏适应证、起搏模式、起搏参数和导线特征)、并发症以及术中参数和长期随访情况.结果:13例接受永久起搏器治疗的...

Transvenous Permanent Pacemaker Implantation in 13 Patients With Dextrocardia

Objectives:Dextrocardia is a rare congenital anomaly.Transvenous pacing leads implantation can be challenging for patients with dextrocardia because of the distorted anatomy.Methods:Thirteen cases of patients with dextrocardia,who underwent pacemaker implantation in Fuwai hospital between March 2008 and February 2019,were included in this retrospective study.Baseline parameters were obtained and outcome data,including pacing characteristics,the complications associated with pacemaker implantation and long-term prognosis were analyzed.Results:The average age was(41.0±16.0)years,and 3(23.1%)were male.Of them,six were dextrocardia with situs solitus and seven were dextrocardia with situs inversus.Nine(69.2%)patients suffered from other congenital heart diseases.The indication for pacemaker implantation was atrioventricular(AV)block(n=6),sinus node dysfunction(n=6)and binodal disease(n=1).Transthoracic echocardiography were performed in all patients and preoperative augmented-reality computed tomography(CT)scan were performed in 4 patients to reveal the anatomy of venous system.Pacemaker implantation were successful in all patients(11 DDD pacemakers and 2 VVI pacemakers).The atrial and ventricular pacing threshold were(0.8±0.4)V/0.4 ms and(0.6±0.2)V/0.4 ms,respectively.The P wave and R wave amplitude were(3.3±1.3)mV and(11.0±3.8)mV,respectively.Atrial lead dislocation was found in one case and resolved by reposition with an active lead.A favorable outcome was noted during a mean follow-up o(f 4.4±2.6)years and two patients underwent pulse generators replacement during follow-up period.Conclusions:Permanent pacemaker implantation in patients with dextrocardia is feasible.Delineating the chamber anatomy and anatomic relationship by preoperative transthoracic echocardiography and CT scan are helpful for the successful pacing lead implantation.Pacing parameters are stable during the mid-term and long-term follow-up.Successful pacemaker implantation in dextrocardia patients is associated with a favorable mid-and long-term outcome.