心室同步化治疗保留左室电极导引钢丝技术的初步探讨

Cardiac resynchronization therapy with retained left ventricular electrode guidewire: a preliminary investigation of the technology

目的对比分析心室同步化治疗在保留左室电极导引钢丝前后的起搏参数,探讨该技术的有效性和可行性。方法 2009年6月—2012年6月收集左室电极植入困难患者8例,在保留左室电极导引钢丝前后分别测定起搏参数,包括起搏阈值、电极阻抗和膈肌刺激阈值,并在术后1、3、6和12个月进行门诊程控随访,在多普勒超声指引下进行参数优化。结果保留钢丝前后的起搏阈值、电极阻抗和膈肌刺激阈值分别为(4.58±1.57)V比(2.12±1.35)V,(1 060±182)Ω比(640±213)Ω和(9.81±2.05)V比(5.64±2.97)V,保留钢丝明显降低起搏阈值、降低电极阻抗和膈肌刺激阈值,差异有统计学意义(P<0.05)。术后12个月随访,所有患者心力衰竭症状改善,左室电极起搏参数与保留钢丝后即刻差异无统计学意义(P>0.05),2例患者在体位变动时有膈肌刺激。结论心室同步化治疗时,保留左室电极导引钢丝能有效改善起搏参数,安全可行。远期随访,膈肌刺激和钢丝断裂的问题有待观察。

Objective To investigate the effectiveness and feasibility of cardiac resynchronization therapy with retained left ventricular electrode guidewire by comparing the pacing parameters with those determined before the retention of left ventricular electrode guidewire. Methods A total of eight patients, who were encountered at the hospital during the period from June 2009 to June 2012 and in whom the implantation of left ventricular electrode was very difficult, were enrolled in the study. Before and after the retention of left ventricular electrode guidewire, the pacing parameters, including pacing threshold, electrode impedance and phrenic nerve stimulation threshold, were determined. Clinical follow-up was conducted at one, 3, 6 and 12 months after the treatment. The pacing parameters were optimized under Doppler ultrasound guidance. The results were analyzed. Results Before the retention of left ventricular electrode guidewire, the pacing threshold, electrode impedance and phrenic nerve stimulation threshold were （4.58 ± 1.57）V, （1 060 ± 182）fl and （9.81 ± 2.05）V respectively, while after the retention of left ventricular electrode guidewire the pacing threshold, electrode impedance and phrenic nerve stimulation threshold were （2.12 ± 1.35）V, （640 ± 213）fi and （5.64 ± 2.97）V respectively. After the retention of the guidewire, the above mentioned pacing parameters were significantly decreased when compared with those obtained before the retention of the guidewire （P 〈 0.05）. Follow-up at 12 months after the treament showed that clinical symptoms due to heart failure were markedly improved in all patients, and little change could be found in the pacing parameters when compared with those determined immediately after the retention of the guidewire （P 〉 0.05）. The stimulation of diaphragm occurring in changing body position was seen in two patients. Conclusion During the performance of cardiac resynchronization therapy, the retention of left vemrieular electrode guidewire is safe and feasible. This technique can effectively improve the pacing parameters, although the stimulation of diaphragm and the fracture of the guidewire occurring in a long-term period need to be further assessed.