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采用主动固定冠状窦导线可提高心脏再同步治疗植入的成功率。

Improved success rate of cardiac resynchronization therapy implant by employing an active fixation coronary sinus lead.

机构信息

Heart Centre Osnabrueck-Bad Rothenfelde, Schuechtermann-Klinik, Ulmenallee 11, 49214 Bad Rothenfelde, Germany.

出版信息

Europace. 2010 Jun;12(6):825-9. doi: 10.1093/europace/euq078. Epub 2010 Mar 21.

Abstract

AIMS

Cardiac resynchronization therapy (CRT) is the standard treatment for heart failure with severe reduced left ventricular (LV) function and wide QRS complex. Coronary sinus (CS) lead implantation is challenging and accompanied by substantial dislocation rates. We evaluated the usage of an active fixation LV lead (Attain Starfix, Medtronic, MN, USA) with deployable lobes in challenging lead positions.

METHODS AND RESULTS

Between September 2006 and August 2009, 678 CRT devices were implanted. In 82 patients (12%) (59 male, 70 +/- 10 years, 39 ICM, 41 DCM, 2 valvular CM, LVEF 28 +/- 9%, NYHA 3.0 +/- 0.4, QRS 169 +/- 29 ms), the Attain Starfix active fixation lead was used. The main reason was intra-operative dislodgement of one (n = 47) or two (n = 5) passive fixation leads during implantation or revision procedure (n = 30). Active fixation lead implantation was overall successful with 90% (n = 74). Anatomical peculiarity was mostly an optimal lead position in otherwise unstable proximal parts of the target vein or a circumscripted areal of optimal threshold without phrenic nerve stimulation. At median follow-up of 99 days the threshold remained stable (1.2 +/- 0.8 vs. 1.0 +/- 0.5 V at 0.5 ms). Revisions due to instability in ectatic vein (n = 1) after 12 months and extractions (n = 2) because of device perforation/infection after 6/15 months were performed without complication.

CONCLUSION

The Attain Starfix active fixation lead proved to be an important option in anatomically challenging, otherwise unstable positions often located in the proximal part of the target vein. Lead revisions or extractions as late as 15 months after implantation were feasible.

摘要

目的

心脏再同步治疗(CRT)是治疗严重左心室(LV)功能降低和宽 QRS 复合物的心力衰竭的标准治疗方法。冠状窦(CS)导联植入具有挑战性,且伴有大量脱位率。我们评估了在具有挑战性的导联位置中使用可展开叶的主动固定 LV 导联(Attain Starfix,Medtronic,MN,USA)的效果。

方法和结果

2006 年 9 月至 2009 年 8 月,共植入 678 个 CRT 设备。在 82 例(12%)患者(59 名男性,70±10 岁,39 例 ICM,41 例 DCM,2 例瓣膜性 CM,LVEF 28±9%,NYHA 3.0±0.4,QRS 169±29ms)中使用了 Attain Starfix 主动固定导联。主要原因是在植入或修订过程中,一个(n=47)或两个(n=5)被动固定导联术中脱位(n=30)。主动固定导联植入总体成功率为 90%(n=74)。解剖学特殊性主要是在目标静脉的不稳定近端部分具有最佳的导联位置,或者在没有膈神经刺激的情况下具有最佳阈值的局限区域。在中位随访 99 天,阈值保持稳定(1.2±0.8 与 0.5 ms 时的 1.0±0.5 V)。在 12 个月后因静脉扩张导致不稳定而进行的修订(n=1),以及在 6/15 个月后因设备穿孔/感染而进行的提取(n=2),均无并发症发生。

结论

Attain Starfix 主动固定导联在解剖学上具有挑战性的位置,通常位于目标静脉的近端部分,且不稳定的位置中,是一种重要的选择。在植入后 15 个月,甚至可以进行导联修订或提取。

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