成角角度法指导下的室间隔起搏导线植入的研究

Implantation of ventricular septum pacing leads guided by angulation method

目的通过成角角度法指导室间隔起搏导线的植入,以期进一步提高起搏导线植入到室间隔的成功率。方法选取病态窦房结综合征或Ⅱ度、Ⅲ度房室传导阻滞患者102例,按照笔者前期研究的成角角度法将起搏导线植入至右心室室间隔,术后行双源CT检查,验证起搏导线的精确位置并分析起搏后的心电图特征。结果 102例患者植入起搏器后通过双源CT均清晰显示了心脏室间隔的解剖结构以及起搏导线位置。植入游离壁15例(14.7%),植入室间隔87例,成功率为85.3%,明显高于前期的研究74%(χ~2=2.85,P<0.05)。术后起搏心电图分析提示:游离壁起搏的QRS时间显著于高位间隔起搏的QRS时间(t=5.79,P<0.05),室间隔起搏心电图V4起始波均为向下的q波,游离壁起搏心电图V4的起始波向上。结论采用成角角度法来指导室间隔起搏导线植入的可靠性及实用性较强,可在常规植入技术上进一步提高起搏器导线植入到室间隔的比例,有临床推广价值。

Objective To improve the success rate of implantation of pacemaker leads into ventricular septum guided by the angulation method.Methods One hundred and two patients undergoing implantation of pacemaker were included in the study.The leads were implanted to right ventricular septum guided by angulation,the precise location of implanted pacemaker leads was verified by double source computerized tomography（DSCT） and the ECG was analyzed.Results The DSCT showed that the leads were implanted in ventricular septum in 87 cases,and in the rest 15 cases（14.7%） the leads were implanted to free wall.The success rate（85.3%） was significantly higher than that of authors＇ previous retrospective study（74%）（χ^2=2.85,P〈0.05）.The ECG analysis showed that QRS interval of free wall pacing was significantly wider than that of ventricular septal pacing（t=5.79,P〈0.05）.ECG showed that the V4 lead initial wave of ventricular septal pacing was Q wave;while that of free wall pacing was R wave.Conclusion The implantation of ventricular septal pacing leads guided by angulation is reliable and practicable.