应用轨道法植入左室心内膜电极行心脏再同步化治疗

The application of orbital implantation of left endocardial electrode for cardiac resynchronization therapy

目的总结心力衰竭(简称心衰)患者行轨道法植入心脏再同步化治疗(CRT)或CRT除颤器(CRT-D)左室心内膜电极方法及疗效。方法选取本院因无法行冠状静脉窦植入CRT/CRT-D左室心外膜电极的心衰患者6例,通过穿刺房间隔先后建立股静脉-房间隔-股动脉轨道和股动脉-房间隔-锁骨下静脉轨道,完成左室心内膜电极植入术,并比较手术前后心脏超声、心电图及心功能指标。结果 6例患者均成功通过轨道法植入CRT/CRT-D左室心内膜电极,术后1周随访QRS时限较前明显缩窄[(140.83±10.52)ms vs(166.83±13.60)ms,P<0.05],射血分数较前明显增加[(0.37±0.05)vs(0.27±0.04),P<0.05],心功能NYHA分级较前升高1～2级,患者心慌、胸闷等临床症状明显改善;术后1例发生左室电极穿孔,床边心脏超声示心包少量积液,予以左室电极重置后好转,其余无明显并发症。结论轨道法植入CRT/CRT-D左室心内膜电极安全、有效,是部分无法通过冠状窦植入心外膜电极的重要辅助术式。

Objective To summarize the method and effect of orbital implantation of cardiac resynchronization therapy(CRT)or CRT and cardioverter defibrillator(CRT-D)combined with implantation of left ventricular endometrium electrode in patients with heart failure(HF).Method Six patients with HF who were unable to perform implantation of CRT/CRT-D left ventricular epicardial electrode coronary venous sinus in our hospital were selected.Femoral vein-atrial septum-femoral artery orbit and femoral artery-atrial septum-subclavian vein orbit were established successively by puncturing atrial septum,and then complete left ventricular endocardial electrode implantation.Cardiac ultrasound,electrocardiogram and cardiac function were compared before and after surgery.Result All the 6 patients successfully implanted CRT/CRT-D left ventricular endocardial electrode by orbital method.QRS duration was significantly narrowed after 1 week follow-up[(140.83±10.52)ms vs(166.83±13.60)ms,P<0.05],and the ejection fraction was significantly increased[(0.37±0.05 vs(0.27±0.04),P<0.05].After surgery,one patient suffered from left ventricular electrode perforation.Bedside cardiac ultrasound showed a small amount of effusion in the pericardium,which was improved after resetting the left ventricular electrode.Conclusion Orbital method implantation of CRT/CRT-D left ventricular endocardial electrode is safe and effective.