心脏再同步化起搏及除颤器在心力衰竭治疗中的应用

The experience of cardiac resynchronization therapy with cardioversion defibrillator in heart failure

目的总结在心力衰竭治疗中应用心脏再同步化起搏及除颤器(CRT-D)的初步体会和随访结果。方法病例入选标准①左室射血分数(LVEF)≤0.35;②QRS波时限≥120ms;③快速室性心律失常;④心功能分级Ⅱ～Ⅳ级。采用左锁骨下静脉穿刺,左室电极置入冠状静脉后侧分支或后分支,右室电极置入右室心尖,右房电极置入右心耳。结果3例均成功置入CRT-D,无严重并发症。左室电极1例置于心脏侧后静脉,另外2例置于心脏后静脉。除颤测试,2例为20J能量1次除颤成功。另1例20J、30J能量除颤未成功,通过调整除颤波斜率,30J成功除颤。随访期间,3例心功能分级、射血分数均有改善,心室起搏比例均超过95%。2例发生持续性室性心动过速,经抗心动过速起搏或除颤治疗成功转复。结论CRT-D能恢复心脏同步活动和识别、转复恶性室性心律失常,是充血性心力衰竭并恶性室性心律失常的有效治疗方法。

Objective To summarize the usage of cardiac resynchronization therapy with cardioversion defibrillator in congestive heart failure. Methods All patients had ventricular tachycardia, whose left ventricular ejection fractions were 0.35 or less,and QRS durations were 120ms or longer. All left ventricular leads were implanted in lateral or left posterior lateral side branches of coronary sinus. Results All procedures were successfully completed without major complications. Left ventricular leads were placed in cardiac posterior-laterior vein in one patient, and were placed in cardiac posterior vein in the others. The defibrillation threshold was detected by T-shock method. 2 patients were successfully defibrillated by CRT-D with 20 J energy, and the other , who failed with 20 J energy , needed change the the slop of defibrillation wave for successful defibrillating. After 6 to 18 months, all patients showed the increment of heart function and left ventricular ejection fraction with more than 95 percent of ventricular capture. 2 patients experienced ventricular tachycardia, which was inversed by ATP therapy or defibrillation. Conclusions The optimized therapeutic strategy for congestive heart failure is cardiac resynchronization therapy with cardioversion defibrillator