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目的总结分析初期开展心脏再同步化治疗(CRT)慢性心力衰竭(简称心衰)的效果及技术问题。方法对20例植入CRT/CRTD的患者观察术前、术后6个月的心功能指标,描述左室电极的植入过程,随访患者预后。结果术后6个月有关心功能指标均明显改善(P均<0.01),随访32.9±21.9个月,死亡4例,其中1例猝死,3例非心脏原因死亡。左室导线进入冠状窦失败改为右室双位点起搏2例(2/20,10%),左室导线难以固定于靶静脉改为经心中静脉与靶静脉吻合支1例(1/20,5%),冠状静脉阶段性狭窄1例(1/20,5%),术后导线脱位3例(3/20,15%)均成功复位。术前冠状动脉造影/冠状静脉显影9例(9/20,45%),术中测试左室电极刺激膈肌跳动经调整电极位置均可避免。结论 CRT治疗心衰有效;术前冠状动脉/冠状静脉造影对指导和易化左室导线植入有益。右室双位点起搏改善心衰不明显,适当调整电极可避免膈肌刺激。
Objective To summarize and analyze the effects and technical problems of initial cardiac resynchronization therapy (CRT) for chronic heart failure (HF). Methods Twenty patients with CRT / CRTD were enrolled in this study. The cardiac function before and 6 months after operation was observed. The implantation process of left ventricular electrode was described and the prognosis was followed up. Results Six months after operation, the indexes of cardiac function were significantly improved (all P <0.01), followed up for 32.9 ± 21.9 months. Four patients died. One patient died of sudden death and three died of noncardiac causes. Left ventricular lead into the coronary sinus failed to change the right ventricular double-point pacing in 2 cases (2/20, 10%), left ventricular lead fixed in the target vein to the vein and the target vein anastomosis in 1 case (1 / 20,5%), 1 case (1 / 20,5%) of coronary venous stenosis, and 3 cases (3 / 20,15%) of postoperative wire dislocation were successfully reset. Preoperative coronary angiography / coronary vein imaging in 9 cases (9 / 20,45%), intraoperative test of left ventricular electrode stimulated diaphragm beat by adjusting the electrode position can be avoided. Conclusions CRT is effective in treating heart failure. Preoperative coronary / coronary angiography is helpful to direct and facilitate left ventricular lead implantation. Right ventricular double-point pacing improve heart failure is not obvious, the appropriate adjustment of the electrode to avoid diaphragm irritation.