单中心心脏再同步治疗相关并发症分析

Analysis of complications associated with cardiac resynchronization therapy:single-center case analysis

目的回顾性总结单中心心脏再同步治疗(CRT)相关并发症概况为临床对CRT患者的管理提供相关经验。方法本研究为回顾性研究,纳入2009年6月至2021年6月在新疆医科大学第一附属医院心血管内科植入CRT的心力衰竭(心衰)患者,按照植入装置类型分为心脏再同步治疗除颤器(CRT-D)组和心脏再同步治疗起搏器(CRT-P)组,分析患者术中、术后发生左心室导线植入失败、膈肌刺激、冠状静脉系统损伤等相关并发症的情况及原因。结果共纳入469例患者,其中男359例(359/469,76.55%),年龄(62.31±11.69)岁,术前左心室射血分数为34.76%±7.96%,术前QRS时限为(161.82±30.57)ms。左心室导线植入成功率为95.1%(446/499)。术中膈肌刺激2例(0.43%);急性左心衰竭3例(6.40%);冠状静脉夹层15例(3.19%);囊袋血肿4例(0.85%);导线脱位10例(2.13%),其中急性脱位2例(20%)、亚急性脱位4例(40%)、迟发性脱位4例(40%)。结论CRT术中发生相关并发症的风险较高,同时也要警惕和排除发生相关术后并发症的可能。

Objective To retrospectively summarize the complications associated with cardiac resynchronization therapy(CRT)in a single center in order to provide relevant experience for the clinical management of CRT patients.Methods This study is a retrospective study.Patients with heart failure who underwent CRT implantation in the Department of Cardiovascular Medicine,The First Affiliated Hospital of Xinjiang Medical University from June 2009 to June 2021 were included.The patients were divided into cardiac resynchronization therapy defibrillator(CRT-D)and cardiac resynchronization therapy pacemaker(CRT-P)according to the type of implanted device.In the CRT-P group,the failure of left ventricular lead implantation,diaphragm muscle stimulation,coronary venous system injury and other related complications were analyzed,and the reasons for the complications were recorded.Results A total of 469 patients were enrolled,including 359 males(359/469,76.55%),age(62.31±11.69)years,preoperative mean left ventricular ejection fraction was 34.76%±7.96%,preoperative mean QRS duration was(161.82±30.57)ms.The success rate of left ventricular lead implantation was 95.1%(446/499),intraoperative diaphragm stimulation in 2 cases(0.43%);acute left heart failure in 3 cases(6.40%);coronary vein dissection in 15 cases(3.19%).Hematoma occurred in 4 cases(0.85%),and lead dislocation in 10 cases(2.13%),including acute dislocation in 2 cases(20%),subacute dislocation in 4 cases(40%),and delayed dislocation in 4 cases(40%).Conclusion The risk of complications related to CRT is high,and at the same time,we should be alert and rule out the possibility of related postoperative complications.