Codreanu A, Marçon F, Bosser G, Lucron H, Burger G, Lethor J P, Sadoul N, Dodinot B
Département des maladies cardiovasculaires du CHU de Nancy.
Arch Mal Coeur Vaiss. 2003 May;96(5):499-506.
This study evaluates the problems and the evolution of cardiac stimulation in infants (aged < 3.5 years) by comparing the endocavity and epicardial routes in a retrospective series of 37 patients. Thirty seven patients aged 1.2 +/- 0.9 years treated with epicardial (n = 19) or endocavity (n = 18) stimulation were followed for 10.9 +/- 6.4 years (0.75-24). The 2 patient groups did not differ in age or weight. Four patients were lost to follow up, and 1 died. The functional duration of the first stimulator was not significantly different if the initial approach was epicardial or endocavity. The endocavity probes were introduced by venous denudation in 15 cases and by subclavian puncture in 3 cases. Fourteen of the 19 children fitted by the epicardial route went on to endocavity stimulation, of which 10 were at the first replacement. None of the 18 patients fitted by the endocavity route went on to epicardial stimulation. Out of 11 endocavity probe replacements and 9 atrialisations, the homolateral venous approach was always possible except in 2 cases. In conclusion, the results for the epicardial and endocavity routes are comparable. For technical reasons (calibre of the veins, size of the stimulator) it would appear reasonable if the endocavity route was used, making do initially with a mono chamber stimulation. The advances in the epicardial electrodes abolishes the major handicap (threshold elevation) of this approach which can be advocated when double chamber stimulation seems preferable.
本研究通过比较37例回顾性系列患者的心腔内和心外膜途径，评估了婴儿（年龄<3.5岁）心脏刺激的问题及演变情况。37例年龄为1.2±0.9岁的患者接受了心外膜（n = 19）或心腔内（n = 18）刺激治疗，并随访了10.9±6.4年（0.75 - 24年）。两组患者在年龄或体重方面无差异。4例患者失访，1例死亡。如果初始途径是心外膜或心腔内，第一个刺激器的功能持续时间无显著差异。15例心腔内探头通过静脉剥脱置入，3例通过锁骨下穿刺置入。19例通过心外膜途径安装的患儿中有14例后来进行了心腔内刺激，其中10例是在首次更换时。18例通过心腔内途径安装的患者均未进行心外膜刺激。在11次心腔内探头更换和9次心房化操作中，除2例外，同侧静脉途径总是可行的。总之，心外膜和心腔内途径的结果具有可比性。出于技术原因（静脉管径、刺激器尺寸），如果使用心腔内途径并最初采用单腔刺激似乎是合理的。心外膜电极的进展消除了该途径的主要障碍（阈值升高），当双腔刺激似乎更可取时，可以采用该途径。
