计算机三维电场导航技术指导“零X线”植入双腔起搏器

Non-fluoroscopic implantation of dual-chamber pacemaker guided by three-dimensional electro-anatomic mapping system

目的:在无X光机可用时,探讨采用三维电场导航指引起搏器植入双腔起搏器的可行性。方法:66岁女性患者,因"反复头晕、黑曚2月余,加重1日"确诊为"病态窦房结综合征"。尽管给予异丙肾上腺素持续静脉微泵注射,心电监护仍有多次6 s以上心脏无搏动。遂采用计算机三维电场导航,而不使用X光指引手术。采用EnsiteTM Nav X系统建模右心房、右心耳和右心室,分别植入心室电极和心房电极,测试参数满意,连接圣犹达双腔起搏器,缝合皮下及皮肤。结果:起搏器电极植入时间21 min,手术时间71 min,术后患者心跳恢复正常,术后随访1月起搏器阈值满意。结论:采用计算机三维电场导航,无X射线可为患者成功安装双腔起搏器,降低了对特殊手术室和大型昂贵X光机的要求。

Objective： To explore the feasibility of non-fluoroscopic implantation of dual-chamber pacemaker guided by three-dimensional electro-anatomic mapping system. Method： A 66-year-old woman was admitted with sick sinus syndrome.The patient had recurrent dizzy and amaurosis even treated with isoprenaline infusion. Emergent implantation of pacemaker was required but without the fluoroscopic guidance since other patients were using the C-arm X-ray machine. Using the Nav X electro-anatomic mapping system,we reconstructed the model of right atrium,right atrial appendage,and right ventricle. Atrial and ventricular leads were placed with satisfactory parameter and was collected to a dual-chamber pacemaker. Results： It took 21 minutes for placing the pacing leads. Procedure time was 71 minutes. The pacing threshold value was satisfactory after the procedure and at one month of follow-up. Conclusion： Non-fluoroscopic implantation of dual-chamber pacemaker guided by three-dimensional electro-anatomic mapping system is a choice in the case of X-ray is not available.