Knight Bradley P, Curlett Kristen, Oral Hakan, Pelosi Frank, Morady Fred, Strickberger S Adam
Division of Cardiology, Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor, MI 49109-0022, USA.
J Interv Card Electrophysiol. 2002 Oct;7(2):177-80. doi: 10.1023/a:1020893923079.
The purpose of this study was to determine whether there are any patient characteristics that predict successful use of the cephalic vein for endocardial lead implantation.
One-hundred fifty consecutive patients who underwent implantation of one or more endocardial pacemaker (N = 63) or defibrillator (N = 87) leads using a cephalic vein approach were included in this prospective study. The mean age of the patients was 63 +/- 14 years, and 115 (77%) were men. Ninety-one patients (61%) had coronary artery disease, 77 patients (51%) had hypertension, and 42 patients (28%) had diabetes. The mean ejection fraction was 0.34 +/- 0.17.
At least one lead was successfully implanted using a cephalic vein approach in 96 patients (64%). The most common reason for failure of the cephalic vein approach was a small cephalic vein, found in 25 patients (17%). Independent predictors of successful cephalic vein use were diabetes (p < 0.001), ejection fraction < or = 0.40 (p < 0.05), and male gender (p < 0.05). At least one endocardial lead was implanted in 19 of the 24 (79%) men who had an ejection fraction < or = 0.40 and diabetes, compared to 4 of the 11 (36%) women who had an ejection fraction > 0.40 and did not have diabetes. The only independent predictor of successful cephalic vein implantation among nondiabetics was an ejection fraction < or = 0.40 (p < 0.01). Body size was not an independent predictor of successful cephalic vein use.
Baseline patient characteristics influence the likelihood of successful endocardial lead implantation using a cephalic vein approach. Diabetes, ventricular dysfunction, male gender and are associated with an increased likelihood of a successful implant using the cephalic vein. Smaller leads and and better techniques are needed to improve the success rate of cephalic vein implantation in all patients.
本研究的目的是确定是否存在可预测头静脉用于心内膜导线植入成功的患者特征。
本前瞻性研究纳入了150例连续接受使用头静脉途径植入一个或多个心内膜起搏器（n = 63）或除颤器（n = 87）导线的患者。患者的平均年龄为63±14岁，115例（77%）为男性。91例（61%）患有冠状动脉疾病，77例（51%）患有高血压，42例（28%）患有糖尿病。平均射血分数为0.34±0.17。
96例（64%）患者通过头静脉途径成功植入至少一根导线。头静脉途径失败的最常见原因是头静脉细小，见于25例（17%）患者。头静脉使用成功的独立预测因素为糖尿病（p < 0.001）、射血分数≤0.40（p < 0.05）和男性（p < 0.05）。在射血分数≤0.40且患有糖尿病的24例男性中，19例（79%）至少植入了一根心内膜导线，而在射血分数>0.40且未患糖尿病的11例女性中，只有4例（36%）植入了导线。在非糖尿病患者中，头静脉植入成功的唯一独立预测因素是射血分数≤0.40（p < 0.01）。体型不是头静脉使用成功的独立预测因素。
患者的基线特征影响使用头静脉途径成功进行心内膜导线植入的可能性。糖尿病、心室功能障碍、男性与使用头静脉成功植入的可能性增加相关。需要更小的导线和更好的技术来提高所有患者头静脉植入的成功率。
