心脏再同步化治疗中腋静脉径路植入左室导线的临床应用评价

Clinical evaluation of left ventricular lead placement via the axillary vein in cardiac resynchronization therapy procedure

目的 :观察慢性心力衰竭患者腋静脉的解剖特征,并探讨心脏再同步化治疗(CRT/CRTD)中经腋静脉途径植入左室导线的可行性和安全性。方法:选择2013年1月—2015年2月行心脏再同步化治疗(CRT或CRTD)患者59例,根据左室导线植入径路分为腋静脉组(n=23)和锁骨下静脉组(n=36),比较两种径路左室导线植入时间、参数及相关并发症;同期选择新植入双腔起搏器(DDD)患者67例,所有患者术前行腋静脉造影,比较慢性心力衰竭和正常心脏结构患者腋静脉内径的差异。结果:所有患者均成功植入CRT/CRTD和DDD装置。心脏再同步化治疗组和双腔起搏器组腋静脉解剖结构相似,两组间腋静脉内径无统计学差异[(10.77±2.19)mm vs(10.11±2.02)mm,P>0.05];心脏再同步化治疗经腋静脉径路和经锁骨下静脉径路植入左室导线的时间、植入并发症无统计学差异(P>0.05);右房、右室、左室导线的阈值、感知、阻抗两组间无统计学差异(P>0.05)。结论 :慢性心力衰竭患者腋静脉内径无明显异常,心脏再同步化治疗中经腋静脉径路植入左室导线安全可行。

Objective：To learn the anatomic features of the axillary vein in chronic heart failure（CHF） patients and to explore the feasibility and safety of left ventricular lead placement via axillary vein pathway in cardiac resynchronization therapy procedure.Methods： Fifty nine CHF patients（35 male with mean age of 62.32 ± 10.33 years old） underwent CRT or CRTD device implantation from January 2013 to February 2015 were randomly divided into the axillary vein group（n=23） and the subclavian vein group（n=36）.The successful rate and time-consuming of the left ventricular lead piacement and related complications were compared. Sixty seven patients（41 male with mean age of 64.34 ± 11.77 years old） underwent dual-chamber pacemaker（DDD） implantation were recruited during the same period for comparison of axillary vein diameter with CHF patients. All patients received axillary venography before procedure. Diameter of the axillary vein was compared between CRT / CRTD patients and DDD patients. Results： All patients successfully implanted the devices. There were no significant differences of axillary vein diameter between the CRT / CRTD group and the DDD group [（10.77 ± 2.19） mm vs.（10.11 ± 2.02） mm, P 〉0.05]. The successful implantation time of left ventricular lead was similar between the two groups. No left ventricular lead implantation related complications occurred. There were no significant differences of pacing threshold, sense and impedance of right atrium, right ventricle and left ventricular lead（P〉 0.05）. Conclusion： The diameter of the axillary vein was normal in chronic heart failure patients. The left ventricular lead placement via the axillary vein is safe and feasible in cardiac resynchronization therapy procedure.