经皮冠状动脉成形术导丝在经冠状窦左室电极安置中的应用

The application of percutaneous transluminal coronary angioplasty guide wire in left ventricular electrode implantation

目的研究和总结经皮冠状动脉成形术(PTCA)导丝在心脏再同步化治疗(CRT/CRT-D)患者左室起搏电极导线安置中的应用价值和技巧。方法 32例患者,心功能(NYHA分级)Ⅲ～Ⅳ级。左室射血分数0.31±0.05(0.23～0.35),左室舒张末期内径70±10(60～78)mm。根据冠状静脉窦及心脏静脉造影结果选择左室起搏电极的靶静脉,选用左室后静脉18例,心侧静脉14例。根据心脏静脉走行选择PTCA导丝(BMW导丝19例,ATW导丝8例。采用双导丝技术2例)或直接使用左室起搏电极的配套导丝(3例)将左室起搏电极送至靶静脉。结果左室起搏电极一次植入成功31例,另1例首次植入失败,第2次手术获得成功。左室电极首次植入成功率为97%。左室起搏阈值1.2±0.5V,阻抗947±231Ω,R波振幅10±3mV。结论应用PTCA导丝,并借鉴PTCA的一些操作技巧,可大幅提高经冠状窦左室起搏电极的植入成功率。

Objective To study and summarize the values and skills of percutaneous transluminal coronary angioplasty （FFCA） guide wire in cardiac resynchronization therapy. Methods A total of 32 patients were selected, whose cardiac function （ NYHA classification） were Ⅲ - Ⅳ grade,left ventricular ejection fraction 0.31 ± 0.05 （ 0.23 - 0.35 ）, and left ventricular end diastolic diameter 70 ±10 （60 -78 ）mm. According to the result of coronary sinus and cardiac vein angiography, the target vein of left ventricular pacing electrode were chosen. Eighteen patients were definited with posterior vein of left ventricle, 14 cases with cardiac lateral vein. According to the running of cardiac vein, the kinds of PTCA guide wire were chosen（ 19 cases with BMW guide wire , 8 cases with ATW guide wire, 2 cases with two-wire technology used）or directly sent the left ventricular electrode to the target vein with left ventricular pacing electrode supporting wire （3 cases）. Results Of all the cases, 31 cases were successfully implanted with left ventricular electrode in the first attemp, 1 case successed in the second procedure. The success rate of first implantation of left ventricular electrode was 97%. The acute left ventricular pacing thresholds were 1.2 ± 0.5 ∨ , left ventricular sensing thresholds were 10 ± 3 mV, the impedances of left ventricular pacing electrodes were 947 ± 231 Ω. Conclusion The application of PTCA guide wire and operating skills can effectively increase the success rate of left ventricular pacing electrode implantation.