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目的探讨经胸心外膜左心室导线植入在慢性充血性心力衰竭心脏再同步化治疗中的意义。方法对1例经静脉植入左心室导线因冠状静脉窦开口畸形而放弃的患者行经胸植入左心室心外膜导线植入。结果右心房、右心室心内膜起搏导线植入及两根心外膜起搏导线缝合均顺利,术后未出现严重并发症。术后2周后临床症状逐渐改善,NYHA心功能分级从术前Ⅲ、Ⅳ级提高至Ⅱ级,LVEDD从72mm减至66mm,优化程控起搏器后超声心动图描记术检查室间隔基底部与左心室侧壁间失同步性改善,第3天心外膜起搏导线阈值从术中的2.0V降为0.5V且稳定。已随访12周临床症状、心功能改善,组织多普勒显像示左心室内恢复同步化。结论心脏再同步化治疗经胸心外膜左心室导线植入是安全、可行的,特别是对经静脉途径失败的患者,是可选择的方法之一;术中左心室导线的定位及术后的综合处理十分重要。
Objective To investigate the significance of transthoracic epicardial left ventricular lead implantation in cardiac resynchronization therapy of chronic congestive heart failure. Methods One patient with left ventricular catheter implanted by left ventricular extracorporeal cable undergoing coronary sinus venous anomalies was implanted. Results Right atrium, right ventricular endocardial pacing lead implantation and two epicardial lead suture were smooth, no serious postoperative complications. After 2 weeks, the clinical symptoms improved gradually. NYHA function improved from grade Ⅲ and Ⅳ to grade Ⅱ, and the LVEDD decreased from 72mm to 66mm. The pacemaker echocardiogram was used to check the base of the septum and The loss of synchrony in the left ventricle wall was improved. On the third day, the epicardial lead threshold was reduced from 2.0 V to 0.5 V and stabilized. The 12-week follow-up of clinical symptoms, improvement of cardiac function, and tissue Doppler imaging showed synchronized left ventricular recovery. Conclusions Cardiac resynchronization is a safe and feasible method for the treatment of thoracic epicardial left ventricular lead implantation, especially for those patients who fail the intravenous route. This is one of the methods that can be selected. Intraoperative left ventricular lead localization and postoperative The comprehensive treatment is very important.