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目的:本文旨在评价左室四极导线在心脏再同步治疗(CRT)中的应用价值。方法:回顾性分析2014-01-2015-12在浙江大学医学院附属第二医院行CRT时植入美国圣犹达公司左室导线的患者46例,其中四极导线组22例,双极导线组24例,比较两组患者左室导线植入时间、植入部位、起搏向量选择等,术后随访6~12个月,比较两组术后膈神经刺激(PNS)、导线脱位等并发症发生率及CRT反应性等临床疗效。结果:两组患者的术前左室舒张末期内径(LVEDd)、左室射血分数(LVEF)和伴随疾病等差异均无统计学意义(P>0.05)。四极组左室导线植入时间短于双极组,但差异无统计学意义[(60.0±33.5)min:(66.2±33.9)min,P>0.05];四极组100%避免了心尖部起搏,双极组仍有4例(16.7%)左室导线起搏于心尖段(P<0.05);术中四极组8例出现PNS,双极组出现5例,四极组仅1例更换靶血管,7例均通过调整起搏向量解决(P<0.01),而双极组均更换靶血管。术后随访(13.4±4.1)个月,两组患者NYHA、LVEF均较术前显著改善(P<0.05);与双极组相比,四极组术后6个月LVEF(42.1±6.6)%:(35.1±8.7)%,P<0.05]、CRT反应性(81.8%:54.2%,P<0.05)改善更显著。术后四极组4例出现PNS,均通过调整起搏向量解决,双极组2例出现PNS,通过降低输出和增加脉宽后解决。四极组1例术后1个月左室导线脱位。结论:左室四极导线在避免心尖部起搏、减少PNS、缩短CRT植入时间上具有明显优势,短期提高CRT反应性高于双极导线。
Purpose: This article aims to evaluate the value of LV quadrupole lead in cardiac resynchronization therapy (CRT). Methods: Retrospective analysis of 2014-01-2015-12 46 patients with left ventricular lead implanted in the United States St. Jude Company CRT at the Second Affiliated Hospital of Zhejiang University School of Medicine 2014-01-2015-12, of which 22 cases of quadrupole lead group, bipolar lead (N = 24). The left ventricular lead implantation time, implantation site and pacing vector selection were compared between the two groups. The patients were followed up for 6 to 12 months. The incidence of phrenic nerve stimulation (PNS) and wire dislocation were compared between the two groups The incidence of disease and CRT response and other clinical effects. Results: There was no significant difference in preoperative left ventricular end diastolic diameter (LVEDd), left ventricular ejection fraction (LVEF) and concomitant disease between the two groups (P> 0.05). The left ventricular lead implantation time in the quadrupole group was shorter than that in the bipolar group, but the difference was not statistically significant [(60.0 ± 33.5) min: (66.2 ± 33.9) min, P> 0.05] There were still 4 cases (16.7%) left ventricular pacing in apical segments in bipolar group (P <0.05). PNS was found in 8 cases in bipolar group, 5 cases in bipolar group and 1 in bipolar group Example of target vessel replacement, 7 cases were resolved by adjusting the pacing vector (P <0.01), while the bipolar group were to replace the target vessel. Compared with the bipolar group, the LVEF (42.1 ± 6.6) and the LVEF of the quadrupole group at 6 months after operation were significantly higher than those before operation (13.4 ± 4.1) % (35.1 ± 8.7)%, P <0.05]. The response to CRT (81.8% vs 54.2%, P <0.05) improved more significantly. PNS was found in 4 patients after quadrupole surgery, both of which were solved by adjusting pacing vector. PNS was found in 2 patients in bipolar group, which was solved by reducing output and increasing pulse width. One patient in quadrupole group had left ventricular lead dislocated 1 month after operation. CONCLUSION: Left ventricular quadrupole lead has obvious advantages in avoiding apical pacing, reducing PNS and shortening CRT implantation time, and short-term improving CRT response is higher than that of bipolar lead.