左心室四极导线在心脏再同步治疗中的应用价值

The clinical effect of quadripolar left ventricular lead in CRT therapy

目的:本文旨在评价左室四极导线在心脏再同步治疗(CRT)中的应用价值。方法:回顾性分析2014-01-2015-12在浙江大学医学院附属第二医院行CRT时植入美国圣犹达公司左室导线的患者46例,其中四极导线组22例,双极导线组24例,比较两组患者左室导线植入时间、植入部位、起搏向量选择等,术后随访6~12个月,比较两组术后膈神经刺激(PNS)、导线脱位等并发症发生率及CRT反应性等临床疗效。结果:两组患者的术前左室舒张末期内径(LVEDd)、左室射血分数(LVEF)和伴随疾病等差异均无统计学意义(P>0.05)。四极组左室导线植入时间短于双极组,但差异无统计学意义[(60.0±33.5)min:(66.2±33.9)min,P>0.05];四极组100%避免了心尖部起搏,双极组仍有4例(16.7%)左室导线起搏于心尖段(P<0.05);术中四极组8例出现PNS,双极组出现5例,四极组仅1例更换靶血管,7例均通过调整起搏向量解决(P<0.01),而双极组均更换靶血管。术后随访(13.4±4.1)个月,两组患者NYHA、LVEF均较术前显著改善(P<0.05);与双极组相比,四极组术后6个月LVEF(42.1±6.6)%:(35.1±8.7)%,P<0.05]、CRT反应性(81.8%:54.2%,P<0.05)改善更显著。术后四极组4例出现PNS,均通过调整起搏向量解决,双极组2例出现PNS,通过降低输出和增加脉宽后解决。四极组1例术后1个月左室导线脱位。结论:左室四极导线在避免心尖部起搏、减少PNS、缩短CRT植入时间上具有明显优势,短期提高CRT反应性高于双极导线。

Objective：The purpose of this study was to evaluate the clinical effect of quadripolar LV lead implanted in cardiac resynchronization therapy（CRT）.Method：Retrospective analysis was performed on heart failure patients following successful implantation of St.Jude LV lead from January 2014 to December 2015 in The Second Affiliated Hospital,Zhejiang University College of Medicine,with 22 patients in quadripolar LV lead group and 24 in bipolar LV lead group.The duration of LV lead implantation procedure,the implanted position of LV lead and the selected pacing vector during the operation,as well as complications like phrenic nerve stimulation（PNS）and clinical effects like CRT response at 6to 12-month follow-up were compared between the two groups.Result：There were no difference of left ventricular end-diastolic diameter（LVEDD）,left ventricular ejection fraction（LVEF）and concomitant disease between the two groups.The duration of LV lead implantation procedure in quadripolar lead group seemed shorter than those in bipolar lead group,although without statistical difference[（60.0±33.5）min vs（66.2±33.9）min,P〈0.05],and apex pacing in quadripolar lead group was lower（0% vs 16.7%,P〈0.05）.During implantation,PNS was occurred in 8cases in quadripolar lead group,7of which were overcame by reprogramming pacing vector,and 5cases in bipolar lead group,which were all changed their target vessel.After a me-dian follow-up of（13.4±4.1）months,LVEF and NYHA improved significantly（P〈0.05）.Compared with bipolar lead group,LVEF had a greater improvement in quadripolar lead group at 6-month follow-up[（42.1±6.6）% vs（35.1±8.7）%,P〈0.05],and the same as CRT response（81.8% vs 54.2%,P〈0.05）.During follow-up,PNS was occurred in 4cases in quadripolar lead group,which were all overcame by reprogramming pacing vector,and 2cases in bipolar lead group,which were overcame by reducing output and increasing pulse width.LV lead dislocation was happened in one patient in quadripolar lead group at 1-month follow-up.Conclusion：Compared with bipolar LV lead,the Quartet quadripolar LV lead proved to be better at avoiding apex pacing,reducing PNS,shortening the LV lead implantation procedure and improving the clinical effect at short-time follow-up.