Vlay Stephen C, Kort Smadar
Stony Brook Arrhythmia Study and Sudden Death Prevention Center and the Echocardiography Laboratory, Cardiology Division, Department of Medicine, Stony Brook University, Stony Brook, New York, USA.
Pacing Clin Electrophysiol. 2006 Jul;29(7):779-83. doi: 10.1111/j.1540-8159.2006.00434.x.
Alternate site lead placement in cardiac resynchronization therapy has been used successfully but remains to be validated. A 62-year-old heart failure patient in whom coronary sinus lead placement was not possible underwent implantation of the lead in the right ventricular outflow tract (RVOT) and demonstrated clinical improvement as measured by New York Heart Association class and noninvasive parameters. When heart failure recurred, it was determined that his RVOT electrode had been pulled back (Twiddler's syndrome). Repositioning again improved his clinical status and noninvasive hemodynamic measurements. With dual-site right ventricular (RV) pacing there was no echocardiographic measurable intraventricular dyssynchrony. Tissue Doppler imaging correlated with clinical improvement using dual-site RV pacing, providing evidence that this technique may represent a viable alternative in cardiac resynchronization therapy.
心脏再同步治疗中交替部位导线植入已成功应用，但仍有待验证。一名62岁的心力衰竭患者无法进行冠状静脉窦导线植入，于是将导线植入右心室流出道（RVOT），结果显示纽约心脏协会分级和无创参数均表明临床症状有所改善。当心力衰竭复发时，发现其RVOT电极已回缩（捻转综合征）。重新定位后再次改善了他的临床状况和无创血流动力学测量结果。采用双部位右心室（RV）起搏时，超声心动图未检测到室内不同步。组织多普勒成像与双部位RV起搏的临床改善相关，这表明该技术可能是心脏再同步治疗的一种可行替代方法。
