右房左右径大小对右室起搏导线植入难度和稳定性的影响

The enlargement of right atrium horizontal diameter increases the difficulty of ventricular lead implantation and its instability.

目的根据近3年新发12例心室导线脱位病例的临床特点和心脏超声改变,分析尚未充分认识到的原因。方法分析12例施行心室导线脱位后复位术病例,并与同期160例未脱位病例的右房左右径、上下径以及右室上下径、三尖瓣返流程度、手术耗时、心室导线定位前的跨瓣次数。结果脱位病例的心脏参数和跨瓣次数均大于或多于未脱位者。心室导线跨越三尖瓣环困难是其共同点。螺旋电极尽管不能解决跨瓣困难的问题,但可以在心室导线一旦进入心室后,迅速定位、固定良好。复位成功率100%。结论右房结构异常,主要是右房左右径对心室导线植入难度以及稳定性存在明显影响,选用主动固定螺旋电极可能会减少脱位的发生。

Objective To analyze the unrecognized causes that lead to ventricular lead dislodgement in patients with pacemaker implantation. Methods The horizontal diameter and longitude diameter of right atrium, the degree of tricuspid regurgitation, the times to lead crossover the tricuspid before the ventricnlar lead was fixed well and operation time in 12 patients with ventricular lead dislodgement and 160 patients without lead dislodgement at the same period were analyzed. Results Parameters of right heart and the times to lead crossover the tricuspid before the ventricular lead was fixed well in 12 patients were larger or more than those in 160 patients without lead dislodgemeut. It was a common phenomenon to en- counter difficulty while crossing tricuspid valve with ventricular leads. The same problem to cross tricuspid difficultly also was met when using of scroll in fixed lead, but it superiority was in quick positioning and fixed well once the leads gut into ventricles. Successes rate of lead repesition was 100%. Conclusion Structural abnormality of right heart, especially en- largement of right atrium horizontal diameter is an unrecognized cause of lead instability and dislodgement. It is better to se- lect active fixation leads to lower occurrence of ventricnlar lead dislodgement. [ Chinese Journal of Cardiac Pacing and Electrophysiology,2009,23 （ 1 ） ：23 - 25 ]