双房起搏对房性快速性心律失常的治疗

Clinical application of biatrial pacing technique in atrial tachyarrhythmias

目的 :评价双房起搏治疗伴房间传导阻滞 (IACB)患者的阵发性房性快速性心律失常的疗效和安全性。方法 :15例患者均行左锁骨下静脉穿刺 ,X线采用正位和左前斜位 ,依次置入冠状窦、右室、右房电极 ,测试起搏参数满意后 ,经Y型转接器将冠状窦电极和右房电极组成新的双极电极 ,置入后分别行AAT、DDD或DDTA起搏。结果 :1例术中冠状窦电极脱位而放弃双房起搏 ,2例术后冠状窦电极脱位 ,均成功复位 ,2例由于程控不当造成起搏器介导性心动过速 ,其余病例未出现并发症。随访 2～ 32个月 ,9例显效 (6 4 .3% ) ,2例有效 ,3例无效。结论 :双房起搏能有效防治并发高度房间传导阻滞患者的阵发性心房扑动、心房颤动。普通心室电极经冠状窦行永久左房起搏安全、有效、脱位率低 。

Objective:To evaluate the efficacy and safety of biatrial pacing in treating paroxysmal atrial tachyarrhythmias in patients with interatrial conduction block. Method:Under fluoroscopy in frontal and left anterior oblique projection, three leads were placed into coronary sinus (CS), right ventricle (RV) and right atrium (RA) respectively via left subclavian venous route in fifteen patients. A new bi polar lead were composed of CS lead and RA lead through a 'Y' shape adapter after threshold tests. AAT, DDD or DDTA pacing mode was applied after implantation, respectively.Result:One patient abandoned the therapy because of dislocation of CS lead in operation. CS leads dislocated in two patients after operation and both were replaced successfully. Two patients experienced pacemaker mediated tachycardias because of programming inappropriately. The other patients had no complications. There were obvious efficacy in nine patients and partial efficacy in two patients while three of them have no efficacy during follow up (range two months thirty two months).Conclusion:Biatrial pacing can effectively prevent and treat paroxysmal atrial flutter and fibrillation in patients with advanced interatrial conduction block. The ordinary ventricle lead, which is safe, cheap, effective and low in dislocation rate for left atrial pacing through coronary sinus, deserves to be generalized and applied.