12例左心室导线内留置导丝的临床应用

The clinic application of retained guidewire in left ventricular lead-12 cases

目的 探讨左心室导线内留置导丝技术的安全性.方法 为固定反复脱位的左心室导线,2009年2月至2014年2月江苏省多中心共有12例接受心脏再同步治疗（CRT）或心脏再同步治疗除颤器（CRT-D）的患者,左心室起搏导线内留置了经皮腔内冠状动脉成型术（PTCA）导丝.随访观察患者的起搏阈值、阻抗及X线胸片.结果 有1例于术后6个月出现X线影像上可辨认的导线断裂.有2例在术后1个月出现起搏阈值升高伴膈神经刺激,行左心室导线重置术中见留置导丝断裂.有2例分别于术后1、3个月出现起搏阈值升高,随访至今（1～3年）未见起搏阈值继续升高,阻抗及X线影像未见异常.有7例随访至今（1.5 ～4.0年）起搏阈值、阻抗以及X线影像均未见异常.结论 左心室导线内留置导丝有损伤导线的风险,临床应禁止使用.

Objective To investigate the safety of retained guidewire in left ventricular lead.Methods The retained percutaneous coronary intervention（PTCA） guidewire technique had been used in 12 patients for repetitive intraoperative dislocation.The threshold and the impendence of the left ventricular lead were recorded during follow-up.The patients with abnormal parameters took chest X-ray.Results Lead fracture was demonstrated by X-ray 6 months after implant in 1 patient.The marked increase in pacing threshold was recorded one month after implant in 2 patients with phrenic nerves stimulation as well as guidewire fracture.There was pacing threshold increase in 2 patients without changes of impendence and X-ray for 1 to 3 years.There were no changes in threshold,impendence as well as X-ray in 7 patients for 1.5 to 4.0 years.Conclusion Retained guidewire technique should be forbidden because it can damage the lead.