Ussen Bassey, Dhillon Paramdeep S, Anderson Lisa, Beeton Ian, Hickman Mike, Gallagher Mark M
Department of Cardiology, St. George's Hospital, London, UK.
Pacing Clin Electrophysiol. 2011 Mar;34(3):365-9. doi: 10.1111/j.1540-8159.2010.02975.x. Epub 2010 Nov 22.
Cardiac resynchronization therapy (CRT) devices are usually implanted using subclavian vein access, which is associated with the risk of pneumothorax. We examined whether cephalic venous access is an effective alternative to subclavian access by the Seldinger technique for CRT delivery.
We retrospectively analyzed all CRT procedures performed over a 1-year period at our center with respect to the access methods, primary success rate, safety, and efficiency.
We retrospectively analyzed 103 consecutive primary implantation procedures. The procedure was accomplished using cephalic access alone for 54 of 61 (89%) CRT implants attempted by this route. The overall success rate was 100% (61/61) with additional use of subclavian access. CRT implantation via subclavian vein access was successful in 37 of 42 (88%) (P < 0.05 vs cephalic group). The procedure duration was shorter for the cephalic group (118 ± 39 vs 147 ± 36 minutes, P < 0.0005) as were the screening times and radiation exposure (15 ± 9 vs 27 ± 18 minutes and 4.7 ± 5.8 vs 9.3 ± 9.1 Gcm(2) , both P < 0.01). In the cephalic group, procedure duration and radiation exposure diminished significantly with increasing experience of the technique. Complications occurred in two of 61 (3.3%) cases in the cephalic group and three of 42 (7.1%) in the subclavian group (P = NS).
CRT devices can be implanted using cephalic access alone in a large majority of cases. This approach is safe and efficient.
心脏再同步治疗（CRT）设备通常通过锁骨下静脉穿刺植入，这与气胸风险相关。我们研究了经Seldinger技术通过头静脉穿刺植入CRT设备是否是锁骨下静脉穿刺的有效替代方法。
我们回顾性分析了本中心在1年期间进行的所有CRT手术的穿刺方法、首次成功率、安全性和效率。
我们回顾性分析了103例连续的初次植入手术。在尝试通过此途径进行的61例CRT植入手术中，有54例（89%）仅通过头静脉穿刺完成了手术。额外使用锁骨下静脉穿刺时，总体成功率为100%（61/61）。通过锁骨下静脉穿刺植入CRT在42例中有37例成功（88%）（与头静脉组相比，P<0.05）。头静脉组的手术时间较短（118±39分钟对147±36分钟，P<0.0005），筛查时间和辐射暴露也较短（15±9分钟对27±18分钟以及4.7±5.8对9.3±9.1 Gcm²，P均<0.01）。在头静脉组，随着技术经验的增加，手术时间和辐射暴露显著减少。头静脉组61例中有2例（3.3%）发生并发症，锁骨下静脉组42例中有3例（7.1%）发生并发症（P=无显著差异）。
在大多数情况下，CRT设备可仅通过头静脉穿刺植入。这种方法安全且有效。
