Zanon Francesco, Baracca Enrico, Pastore Gianni, Aggio Silvio, Rigatelli Gianluca, Dondina Cristina, Marras Gilla, Braggion Gabriele, Boaretto Graziano, Cardaioli Paolo, Galasso Mariapaola, Zonzin Pietro, Barold S Serge
Division of Cardiology, Rovigo General Hospital, Rovigo, Italy.
Pacing Clin Electrophysiol. 2006 Nov;29(11):1266-72. doi: 10.1111/j.1540-8159.2006.00529.x.
Implantation procedures for cardiac resynchronization therapy (CRT) remain challenging with regard to coronary sinus (CS) cannulation and left ventricular (LV) lead positioning. Technologic advances in catheter design may facilitate CS cannulation and LV lead placement.
To evaluate two different telescoping dual-catheter systems, RAPIDO Guiding Catheter System (Group R) and RAPIDO ADVANCE Guiding Catheter System (Group A) (Guidant Inc., St. Paul, MN, USA), during implantation of a CRT device.
Seventy-four consecutive patients randomly received a CRT device using the R or A system.
An LV lead was successfully implanted in 74 patients (100%). (1) Median times for CS cannulation in groups R and A were 0.3 minutes (range from 0.05 to 14 minutes) and 0.5 minutes (range from 0.05 to 9 minutes), respectively (P = NS). (2) Median times for LV lead placement were 8 minutes (range from 0.8 to 100 minutes) and 3.5 minutes (range from 0.25 to 30 minutes), respectively, for groups R and A (P = 0.032). (3) Median total fluoroscopy times were 12.33 minutes (range from 5 to 70 minutes) and 14.33 minutes (range from 6 to 53 minutes) for groups R and A, respectively (P = NS). (4) Median procedural times for CRT implantation were 80 minutes (range from 40 to 200 minutes) and 75 minutes (range from 45 to 180 minutes) (P = NS) in groups R and A, respectively. There were no major complications.
CS cannulation and LV lead placement with a telescopic dual-catheter system is a safe and feasible approach that may reduce fluoroscopy and overall CRT implantation times. Our observations suggest that the RAPIDO ADVANCE System is faster than the RAPIDO System in terms of median time for LV lead positioning.
心脏再同步治疗（CRT）的植入过程在冠状窦（CS）插管和左心室（LV）导线定位方面仍然具有挑战性。导管设计的技术进步可能有助于CS插管和LV导线放置。
在植入CRT设备期间，评估两种不同的可伸缩双导管系统，即RAPIDO引导导管系统（R组）和RAPIDO ADVANCE引导导管系统（A组）（美国明尼苏达州圣保罗市Guidant公司）。
74例连续患者随机使用R或A系统接受CRT设备植入。
74例患者（100%）成功植入LV导线。（1）R组和A组CS插管的中位时间分别为0.3分钟（范围0.05至14分钟）和0.5分钟（范围0.05至9分钟）（P =无显著性差异）。（2）R组和A组LV导线放置的中位时间分别为8分钟（范围0.8至100分钟）和3.5分钟（范围0.25至30分钟）（P = 0.032）。（3）R组和A组的总透视中位时间分别为12.33分钟（范围5至70分钟）和14.33分钟（范围6至53分钟）（P =无显著性差异）。（4）R组和A组CRT植入的中位手术时间分别为80分钟（范围40至200分钟）和75分钟（范围45至180分钟）（P =无显著性差异）。无重大并发症。
使用可伸缩双导管系统进行CS插管和LV导线放置是一种安全可行的方法，可能会减少透视时间和CRT植入总时间。我们的观察结果表明，就LV导线定位的中位时间而言，RAPIDO ADVANCE系统比RAPIDO系统更快。
