经头静脉双扩张行双腔起搏器安置

Installation of dual chamber pacemaker via double expansion of cephalic vein

目的观察82例按常规经头静脉置入起搏电极失败者,改用经头静脉双扩张法送入起搏电极安置双腔起搏器,探讨该方法的可行性、安全性。方法沿胸大肌与三角肌之间的肌间沟做斜行切口3.5cm。在肌间沟内分离出头静脉,剪开头静脉,送入起搏电极,送入失败者,改用双扩张头静脉方法,分别送入心室和心房电极。结果从头静脉送入起搏电极未成功的82例,改用经头静脉双扩张法送入起搏电极成功75例。其中有7例改用泥鳅钢丝后头静脉扩张成功。成功率为91.4%。未成功的7例改为穿刺锁骨下静脉送入起搏电极。结论经双扩张头静脉送入心室、心房电极安置双腔起搏器,增加了从头静脉送入2根电极的成功率,方法简单、可行。有效地减少因穿刺锁骨下静脉发生的近远期并发症。

Objective To observe the failure example of implanting the pacing electrode via cephalic vein with the routine method. To discuss the feasibility and safety of installing dual chamber pacemaker via double expansion method of cephalic vein as replacement method. Methods To cut a 3.5cm of oblique incision along the intermuscular groove between ectopectoralis and deltoid. To detach the cephalic vein in the intermuscular groove, and to cut the cephalic vein and send the pacing electrode. For the failure example, double expansion method of cephalic vein was selected as a replacement method. The electrodes were sent into the ventricle and atrium, respectively. Results The implantation of pacing electrode through cephalic vein in 82 patients was unsuccessful, but 75 of them succeeded after double expansion method of cephalic vein. Among them, 7 cases succeeded with steel wire to implant through cephalic vein. The total success rate was 91.4%. In the other unsuccessful cases, the subclavian vein was punctured for sending the pacing electrode as the replacement method. Conclusions To send electrodes into ventricle and atrium through double expansion method of cephalic vein to instal dual chamber pacemaker is simple and feasible. Meanwhile, it increases the success rate of the implantation of two electrodes through cephalic vein, and effectively reduces the recent and future complications of subclavian vein puncture.