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左心室四极导线在心脏再同步治疗中的临床应用 被引量:5

The clinic effect of quadripolar left ventricular lead in cardiac resynchronization therapy
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摘要 目的探讨左心室4极导线在心脏再同步治疗(CRT)中的作用。方法回顾性分析2014年2月至2015年7月在南京大学医学院附属鼓楼医院行CRT或心脏再同步治疗除颤器(CRT-D)植入中应用左心室4极导线患者20例,并挑选左心室大小、射血分数以及病因相匹配的20例植入传统左心室双极导线患者.组成1:1配对。比较两组患者手术时间,X线曝光时间,左心室导线位置,左、右心室传导时间(LV-RV conduction time)差异。术后随访1年,比较两组患者膈神经刺激(PNS)发生率,左心室平均起搏阈值、导线脱位率、左心室舒张末期内径(LVEDD)、左心室射血分数(LVEF),以及再住院率。结果4极导线组手术时间[(102.85±12.01)]min对(114.70±19.36)min,P〈0.05]、X线曝光时间[(16.90±2.13)]min对(22.5±3.57)min,P〈0.05]及PNS发生率(0对25%,P〈0.05)均小于双极导线组;4极导线组导线定位于左心室侧壁血管(90%对65%,P〈0.05)和非心尖部比例(100%对85%,P〈0.05)高于双极导线组;4极导线组左、右心室传导时间较双极导线组长(30.95ms对26.00ms,P〈0.05)。随访1年,4极导线组左心室起搏阈值较双极导线组低[(1.20±0.55)V/0.4ms对(2.35±0.96)V/0.4ms,P〈0.05]。两组LVEF及LVEDD变化、导线脱位率和再住院率差异无统计学意义。结论左心室4极导线能降低CRT的手术难度,提高手术成功率,值得临床广泛使用。 Objective To investigate the application of quadripolar left ventricular lead in cardiac resynchronization therapy (CRT). Methods Twenty patients implanted CRT/cardiac resynchronization therapy defibrillator (CRT-D) with quadripolar left ventricular lead were matched 1 : 1 with regard to left ventricular end diastolic diameter (LVEDD), left ventricular ejection fraction (LVEF) and the etiology of cardiomyopathy to a retrospective cohort of 20 patients who implanted CRT with bipolar lead.The position of left ventricular lead, duration of procedure, fluoroscopy time,phrenic nerve stimulation (PNS) ,left ventrieular-right ventrieular (LV-RV) conduction time,left ventricular pacing threshold, LVEDD and LVEF at 12-month follow-up were compared be- tween the two groups. Results The procedure duration and the time of fluoroscopy in quadripolar group were shorter than these in biopolar group ( 102. 85+ 12. 01 ) min vs. ( 114. 70±19. 36) min ,P〈0. 05 ; ( 16. 90±2. 13) min vs. (22. 5±3. 57) min ,P〈0. 05] ,and incidence of PNS was lower(0 vs. 25% ,P〈0. 05).The rates of the target vein located in lateral position(90%vs. 65%,P〈0. 05) and the non apical region (100% vs. 85%,P〈0. 05) in quadripolar group were higher than those in bipolar group.There was longer LV-RV conduction time in quadripolar group than that in bipolar group (30. 95 ms vs. 26. 00 ms,P〈0. 05).There were no significant differences in the LVEF,LVEDD, the rates of lead dislocation and rehospitalization between two groups,bnt the left ventricular pacing threshold in quadripolar group was lower than that in bipolar group [(1.20±0.55) V/0.4 ms vs.(2.35±0.96) V/0.4 ms, P〈0. 05]. Conclusion Quadripolar left ventricular lead is worthy of popularization and application,which can simplify the procedure and increase the success rate of left ventricular lead implantation.
出处 《中华心律失常学杂志》 2016年第6期477-480,共4页 Chinese Journal of Cardiac Arrhythmias
关键词 左心室4极导线 心脏再同步治疗 膈神经刺激 Quadripolar left ventricular lead Cardiac resynchronization therapy Phrenic nerve stimulation
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