左室心内膜起搏实现心脏再同步化治疗的临床研究

Clinical study of left ventricular endocardial pacing in cardiac resynchronization therapy

目的评价经房间隔穿刺或室间隔穿刺途径植入左室心内膜电极行心脏再同步化治疗的有效性和安全性。方法回顾性分析2014年8月-2018年10月在中国科学技术大学附属第一医院(安徽省立医院)诊治的6例冠状静脉畸形或CRT无反应的慢性心力衰竭患者,经房间隔穿刺或室间隔穿刺途径植入左室心内膜电极行心脏再同步化治疗,其中4例经房间隔穿刺,2例行室间隔穿刺。测量术前术后QRS波宽度,及术后随访3、6、12、24个月左室射血分数(LVEF)、左室舒张末内径(LVEDD)、左室收缩末内径(LVESD)、左房前后径(LAD)大小及心功能分级等变化,以及左室心内膜电极的参数(阈值、阻抗)变化情况。结果 6例患者均成功经房间隔穿刺或室间隔穿刺植入左室心内膜电极,术中无严重并发症发生。术后测QRS宽度较术前明显缩窄;随访24个月内,左室射血分数(LVEF)较术前明显提高,左室舒张末内径(LVEDD)较术前明显缩小;左室收缩末内径(LVESD)、左房前后经(LAD)大小无明显变化,左室电极的参数(阈值、阻抗)较稳定;术中及术后随访过程中无膈肌刺激、无血栓栓塞、出血及室性心律失常等明显不良事件发生,患者心功能得到明显改善,无一例死亡。结论经房间隔穿刺或室间隔穿刺植入左室心内膜电极获得成功,并获得了一定的临床疗效。

Objective To evaluate the efficacy, safety of cardiac resynchronization therapy(CRT) with atrial septal or ventricular septal puncture implanted into the left ventricular endocardial electrode. Methods A retrospective analysis of 6 heart failure patients with coronary venous malformation or CRT nonresponse diagnosed at the First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China from August 2014 to October 2018, with left ventricular endocardial electrodes implanted through atrial septal or ventricular septal puncture. Among them, 4 patients underwent atrial septal puncture and 2 patients’ ventricular septal puncture. The QRS width was got before and after operation, and left ventricular ejection fraction(LVEF), left ventricular end-diastolic diameter(LVEDD), left ventricular end-systolic diameter(LVESD), left atrial anterior and posterior diameter(LAD) and cardiac function grading were measured, and parameters of left ventricular electrode(threshold, impedance) were measured after 3, 6, 12 and 24 months. Results Six patients underwent successful implantation of left ventricular endocardial electrodes through atrial septal or ventricular septal puncture. There were no serious complications during operation. The QRS width was significantly narrower than before. LVEF was significantly increased and LVEDD was significantly reduced within 24 months;LVESD and LAD were unchanged, and parameters of left ventricular electrodes(threshold, impedance) were relatively stable, no obvious abnormal events such as diaphragmatic stimulation, thromboembolism, hemorrhage and ventricular arrhythmia, and the patient’s heart function was significantly improved. None was deaths. Conclusion The left ventricular endocardial electrode is successfully inserted through the atrial septal or ventricular septal puncture, and certain clinical efficacy is obtained.