右心室流入道间隔部起搏的临床可行性

Clinical feasibility of right ventricular inlet septal pacing

目的 探讨右心室流入道间隔部起搏的临床可行性 ,以获得较生理的心室激动顺序。 方法 对 10例有按需型心室起搏 (VVI pacing)适应证的患者 ,以心内希氏束导管的顶端为 X线影像下的参考标志 ,放置螺旋电极起搏导线 ,导线向其远端上方移动 ,寻找适当的植入位置。若起搏时导线电极记录的局部心室电图的起点比希氏束上的 V波提前 ,且起搏的 QRS波与自身窦性搏动的 QRS波相似 ,这个部位便是右心室流入道间隔部位。 结果 10例患者均成功地植入了导线和脉冲发生器 ,术中测试的阈值为 (0 .5 0± 0 .2 5 ) V。起搏的 QRS时限平均 (12 4.77± 11.35 ) m s。随访平均 8个月 ,起搏阈值无显著改变 ,未发生导线脱位和其它等并发症。 结论 右心室流入道间隔部起搏在临床上是可行的。

Objective To explore the clinical feasibility of right ventricular inlet septal pacing in order to get more physiological ventricular activation sequence. Method In 10 patients indicated for permanent VVI pacing tried to implant the pacing lead to the right ventricular inlet septal region under fluoroscopy and taking the tip of His bundle catheter as the reference.The pacing lead moved upward and distally to find the optimal implant location.If the local ventriculogram recorded during pacing appeared earlier than the V wave of His bundle electrogram and the shape of QRS wave during pacing is similar to that of spontaneous sinus beat,suggest the lead is located at the right ventricular inlet septal region. Results The lead and pulse generator were successfully implanted in all 10 patients.The average pacing threshold measured during implant procedure was (0 50±0 25) V.The QRS duration of paced beat was (124 77±11 35) ms.All patients were followed up 10 months,no significant change of pacing threshold was noted and no lead dislocation and other complications happened. Conclusion Right ventricular inlet septal pacing is clinically feasible.