左心室四极导线在心脏再同步治疗中的临床应用

Application of quadripolar LV lead in cardiac resynchronization therapy

目的评估左心室四极导线在心脏再同步治疗中的临床应用。方法选择符合心脏再同步治疗(CRT)适应证患者30例,分为左心室四极导线组和双极导线组。比较两组在临床疗效、同步性、手术时间及并发症等方面的差异。结果两组患者左室导线置入时间、手术时间、X线曝光时间、左室导线位置均无显著差异。四极导线组可选择的起搏向量远多于双极导线组。术后1个月的超声优化程控显示,四极导线组优化后主动脉射血速度时间积分(AOVTI)和左室同步性均显著改善,同时优于双极导线组优化后(P<0.05)。随访至术后6个月,四极导线组的左室射血分数优于双极导线组(P<0.05)。结论左心室四极导线与双极导线具有同样的安全性,其血液动力学、同步性和短期临床疗效优于双极导线,并可能有助于减少膈神经刺激避免二次手术等并发症。

Objective To evaluate the application of quadripolar left ventricular lead in cardiac resynchronization therapy（ CRT）. Methods Patients who met the indications for CRT were enrolled in this study,and received cardiac resynchronization therapy defibrillator（ CRT-D） device with quadripolar（ quadripolar lead group） or bipolar（ Bipolar lead group） left ventricular Lead. The short term clinical effect,synchronization,operation time and complications were then evaluated. Results There were no significant differences in coronary sinus calculation to final LV lead placement,operation time,fluoroscopy time and the location of LV lead between the two groups. Quadpipolar lead group had significant and more usable configurations than bipolar lead group. Echo optimization showed that the aortic velocity time integral（ AOVTI） and LV synchronization were significantly improved in quadripolar lead group one month after implantation. AOVTI（ 19. 7 ± 0. 8 vs 18. 9 ± 1. 1,P〈0. 05） and LV synchronization（ 78. 9 ± 16. 0 vs 90. 3 ± 12. 0 ms,P〈0. 05） were better in Quadripolar lead group than in bipolar lead group.There were significant differences in left ventricular ejection fraction between the two groups six month after implantation（ 37. 1 ± 5. 1% vs 32. 9 ± 5. 5%,P〈0. 05）. Conclusion The safety of quadripolar LV lead is the same as bipolar one. Quadripolar LV lead ＇s hemodynamics,LV synchronization and short term clinical effect are significantly better than Bipolar LV lead,and may help to reduce phrenic nerve stimulation.