Daoud Emile G, Kalbfleisch Steven J, Hummel John D, Weiss Raul, Augustini Ralph S, Duff Steven B, Polsinelli Georgia, Castor John, Meta Tejas
MidOhio Cardiology, MidWest Research Foundation, Riverside-Methodist Hospital, Columbus 43214, USA.
J Cardiovasc Electrophysiol. 2002 Oct;13(10):964-70. doi: 10.1046/j.1540-8167.2002.00964.x.
The aim of this study is to describe implantation techniques and lead performance for biventricular pacing, dual-chamber implantable cardioverter defibrillators (ICDs).
A dual-chamber ICD with biventricular pacing was implanted in 87 patients with congestive heart failure (ejection fraction: 0.21 +/- 0.09), prolonged QRS duration (161 +/- 22 msec), and an indication for ICD therapy. Left ventricular pacing was achieved with a thoracotomy approach (n = 21) or a nonthoracotomy approach (n = 66). With a thoracotomy, biventricular devices were implanted successfully in all patients. During follow-up (17 +/- 11 months), 9 patients died (43%), 2 underwent transplantation, and 2 required left ventricular lead revision. At last follow-up, biventricular sensing and capture threshold were 11 +/- 5 mV and 1.5 +/- 0.8 V, respectively. For nonthoracotomy procedures, two types of coronary sinus (CS) leads were implanted: an over-the-wire lead (n = 45) and a shaped lead (n = 21). The rate of successful implantation (overall: 89%) (over-the-wire 93% vs shaped 81%; P = 0.1) and durations for CS lead placement (66 +/- 50 vs 58 +/- 34 min, P = 0.6) and the procedure (133 +/- 58 vs 129 +/- 33 min, P = 0.8) were not different between the two CS leads. During follow-up (11 +/- 9 months), 9 patients died (14%), and the shaped CS lead dislodged in 3 patients (3 shaped vs 0 over-the-wire, P = 0.01). At last follow-up, biventricular sensing and capture threshold were 10 +/- 4 mV and 1.8 +/- 0.7 V, respectively, and there was no difference between over-the-wire and shaped leads. By multivariate analysis, mortality was associated with absence of spironolactone therapy but not procedural features.
Nonthoracotomy CS lead implantation is feasible, with a success rate of about 90% and few adverse events. For the remaining 10%, a thoracotomy approach can be completed safely in these ill patients without increased risk for death.
本研究旨在描述双心室起搏双腔植入式心脏复律除颤器（ICD）的植入技术及导线性能。
对87例充血性心力衰竭患者（射血分数：0.21±0.09，QRS时限延长：161±22毫秒）且有ICD治疗指征者植入带双心室起搏功能的双腔ICD。通过开胸手术途径（n = 21）或非开胸手术途径（n = 66）实现左心室起搏。采用开胸手术时，所有患者双心室装置均成功植入。随访期间（17±11个月），9例患者死亡（43%），2例接受移植，2例需要对左心室导线进行修正。在最后一次随访时，双心室感知和捕捉阈值分别为11±5毫伏和1.5±0.8伏。对于非开胸手术，植入了两种类型的冠状静脉窦（CS）导线：钢丝外导线（n = 45）和塑形导线（n = 21）。两种CS导线的成功植入率（总体：89%）（钢丝外导线93%对塑形导线81%；P = 0.1）、CS导线放置时间（66±50对58±34分钟，P = 0.6）及手术时间（133±58对129±33分钟，P = 0.8）无差异。随访期间（11±9个月），9例患者死亡（14%），3例塑形CS导线脱位（塑形导线3例对钢丝外导线0例，P = 0.01）。在最后一次随访时，双心室感知和捕捉阈值分别为10±4毫伏和1.8±0.7伏，钢丝外导线和塑形导线之间无差异。多因素分析显示，死亡率与未使用螺内酯治疗有关，而与手术特征无关。
非开胸CS导线植入是可行的，成功率约为90%，不良事件较少。对于其余10%的患者，在这些病情较重的患者中开胸手术可安全完成，且不会增加死亡风险。
