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目的报道2例心外膜电极导线在心脏再同步治疗(CRT)左心室起搏中的应用及结果。方法2例均因心脏靶静脉解剖结构问题不能经心脏静脉途径植入左心室电极,其中l例为右心室双部位(心尖部+流出道间隔)起搏3个月后无效患者。全麻,气管插管,在左第4肋间腋前线处切口,进胸后切开心包,采用缝线将心外膜电极固定于左室侧后下壁,通过皮辦下隧道把左室电极送入囊袋并与脉冲发生起搏器左室孔相联。结果2例手术顺利,无并发症。术后左室同步性明显好转,心脏射血分数(EF)值增加,心功能改善。结论心外膜导线在CRT左室起搏中的应用是安全、可行的,术后短期随访可获得良好的临床疗效。
Objective To report the application and results of 2 cases of epicardial lead in left ventricular pacing in cardiac resynchronization therapy (CRT). Methods Two cases were implanted with left ventricular electrodes by cardiac venous route because of the anatomical structure of cardiac target vein. Among them, one case was invalid after 3 months of right ventricular double part (apical + outflow tract) pacing. General anesthesia, endotracheal intubation, in the left intercostal axillary line at the incision into the chest after the incision of the pericardium, the epicardial electrode will be fixed to the posterior wall of the left ventricle, through the skin under the tunnel to the left ventricle The electrodes are fed into the capsular bag and associated with the pulsatile pacemaker left ventricular orifice. Results 2 cases of surgery smoothly without complications. Postoperative left ventricular synchrony was significantly improved, the value of cardiac ejection fraction (EF) increased, cardiac function improved. Conclusions The application of epicardial leads in CRT left ventricular pacing is safe and feasible. Short-term follow-up after operation can achieve good clinical efficacy.