心力衰竭再同步治疗中小切口心外膜左心室电极置入的补救技术

Efficacy of minimally invasive left ventrictdar epicardial lead placement for cardiac resynchronization therapy

目的 探讨小切口心外膜左心室电极置入行心脏再同步化治疗.方法 6例心力衰竭患者拟行心脏再同步化治疗,冠状窦途径失败后采用小切口心外膜置入左心室电极,同时经静脉置入右心房、右心室电极.术后随访1年,评价心功能和左心室电极参数.结果 经小切口心外膜途径,所有患者均成功将左心室电极置入到理想部位.无术中并发症,无住院期间死亡,无膈肌刺激征.术中,左心室起搏阈值为（1.2±0.5）V;术后12个月,左心室起搏阈值为（1.1±0.4）V.12个月随访时,6 min步行[（327±77）m比（267±68）m,P=0.001]明显增加,纽约心功能分级明显改善,左室射血分数明显增加[（26.1±6.0）%比（38.2±4.7）%,P：0.004],左心室舒张末期内径明显减少[（72.2±6.8）mnl比（84.1±7.2）mm,P=0.001].结论 小切口心外膜置入左心室电极安全、有效,可以作为经冠状窦途径置人失败患者的替代治疗.

Objective Ventricular resynchronization might be achieved via minimally invasive left ventricular epicardial lead placement Method Six patients with congestive heart failure underwent minimally invasive left ventricular epicardial lead placement after failed coronary sinus cannulation were followed up for 1 year, cardiac function and LV lead threshold were evaluated. Results There were no inhospital deaths, intraoperative complications and diaphragm stimulation. Correct lead positioning was achieved in all 6 patients. LV lead thresholds remained unchanged [（1.2±0. 5）Vvs（l.l±0. 4） V , P = 0. 68 ] at 12 months follow-up. Improvements on 6 min walking test [ （ 327 ± 77） m vs （267 ± 68） m, P = 0.001], LVEF[（26.1 ±6.0）% vs （38.2 ± 4.7）% ,P = 0.004], and NYHA functional class were evidenced at 12 months follow-up. Conclusion Minimally invasive left ventricular epicardial lead placement is a safe and reliable technique and should be considered as an alternative option in case of difficult coronary venous anatomy and inability to position the lead for resynchronization therapy.