经静脉胸前植入单导线植入型心律转复除颤器

Transveneous pectoral implantation of single lead implantable cardioverter defibrillator

目的:总结15例经静脉胸前植入单导线植入型心律转复除颤器的临床应用结果。方法:15例患者,男性13例,女性2例,平均年龄51.7岁。患者植入 ICD 适应证为:心室颤动(室颤)8例,顽固性室性心动过速(室速)7例。所有患者均有院外晕厥史。ICD 均为非开胸经静脉单导线系统,其中Medtronic 7219 C 型2例,7220 C 型3例。除颤电流由右心室心内线圈状电极至除颤器外壳本身。CPIVentak PR×Ⅲ10例,除颤电流由右心室远端线圈状电极至近端线圈状电极。结果:15例患者均成功地植入了经静脉单导线 ICD。平均除颤阈值为12.8J(5～15J)。R 波高度为9.9mV(3.7～14.6mV),电极导线插入途径14例经左锁骨下静脉,1例经右头静脉到右心室。ICD 埋于患者胸前壁肌肉下(11例)或皮下(4例)囊袋,2例发生囊袋血肿,经挤压排出血块、局部压迫纠正。平均随访7.6个月(0.5～18个月),有3例患者发生了室速,由 ICD 抗心动过速起搏及低能量电转复终止。1例室颤经高能量除颤终止。结论:经静脉胸前植入单导线 ICD 是一种操作简单、除颤效果满意的植入方法。

Objective:Since the first Implantable Cardioverter Defibrillator(ICD)was implanted in China in 1991,more than 30 ICD_s by have been implanted and 15 of them were implanted by Fu wai Hospi- tal,et al.after 1996 using nonthoracotomy ICD system.We report our initial experience of transveneous pectoral implantation of single lead ICD in fifteen patients.Methods:15 patients(male 13,female 2, mean age of 53.8+10.1 years),including dilated cardiomyopathy in 4,hypertrophic cardiomyopathy in 2, coronary artery disease in 5 and syncope of unknow cause in 4,underwent ICD implantation.Indications for ICD implantation were VF in 8 patients and refractory VT in 7 patients.All patients had syncope out of hospital.The ICD system were Medtronic Jewel active can in 5 patients(Model 7219C in 2,7220C in 3) and CPI Ventak PR×Ⅲ in 10 patients.For active can,shocks were delivered through distal coil to ICD shell;for PR×Ⅲ,through the proximal to distal coil electrode of the Endotak lead.Successful implantation criterion was 2 consecutive defibrillation at<24 J.Results:All 15 patients had successful implantation using single lead ICD system in Cath Lab.The mean defibrillation threshold was 12.8 J(5～15 J)and in- tracavitary R wave was 9.9 mV(3.7～14.6 mV).11 devices were submuscular and 4 was subcutaneous pectoral implantation.No operative and perioperative complication occurred.In 7.6 months(0.5～18 months)follow-up,3 patients had episodes of VT which were terminated by antitachycardia pacing (ATP),1 patient had VF and was terminated by difibrillation.1 patient died due to heart failure.Con- clusion:Transveneous pectoral implantation of single lead ICD is easy tu perform and has high efficacy de- fibrillation and should be the preferred approach.