巨大心房心脏起搏器的植入方法探讨

The Study on Implanting Way of Pacemaker for Patients with Large Atrium

目的:探讨巨大心房患者起搏器的植入方法。方法:对3例巨大心房患者按常规方法分离头静脉或穿刺锁骨下静脉,植入主动固定螺旋电极完成手术。结果:1例先通过冠状静脉窦进入心中静脉,后因膈肌刺激改为流出道起搏;1例脱位经再次手术成功固定电极在心尖部,1例固定在右室游离壁未出现脱位。结论:对巨大心房患者,起搏电极植入较困难,可采用主动固定电极,但脱位概率仍较大。

Objective：To study the implanting technology of pacemaker with large atrium. Methods：Three patients with large atrium who need to implant pacemaker were enrolled. Through the cephalic vein or subclavian vein, the spiral leads were inserted to right ventricular. Results： One case the lead were first inserted into middle coronary vein. because of stimulating of di- sphragmatic muscle, the lead were fixed to outflow tract of right ventricular. One case the lead was fixed to free wall of right ventricular first but one month later the lead dislocate to right atrium. Then the second operation was performed, the spiral lead was fixed to apical of right ventricular, For the third patient, the lead were fixed to free wall of right ventricular near tricuspid valve. Conclusion： Implanting lead to right ventricular is difficult for the patients with large atrium. For these cases, spiral leads may be helpful than usual leads. But it is more dislocated.