Mihalcz Attila, Kassai Imre, Kardos Attila, Foldesi Csaba, Theuns Dominic, Szili-Torok Tamas
Department of Electrophysiology, Gottsegen Gyorgy Hungarian Institute of Cardiology, Budapest, Hungary.
Pacing Clin Electrophysiol. 2012 Feb;35(2):124-30. doi: 10.1111/j.1540-8159.2011.03239.x. Epub 2011 Oct 20.
Epicardial pacing lead implantation is the currently preferred surgical alternative for left ventricular (LV) lead placement. For endocardial LV pacing, we developed a fundamentally new surgical method. The trans-apical lead implantation is a minimally invasive technique that provides access to any LV segments. The aim of this prospective randomized study was to compare the outcome of patients undergoing either trans-apical endocardial or epicardial LV pacing.
In group I, 11 end-stage heart failure (HF) patients (mean age 59.7 ± 7.9 years) underwent trans-apical LV lead implantation. Epicardial LV leads were implanted in 12 end-stage HF patients (group II; mean age 62.8 ± 7.3 years). Medical therapy was optimized in all patients. The following parameters were compared during an 18-month follow-up period: LV ejection fraction (LVEF), LV end-diastolic diameter (LVEDD), LV end-systolic diameter, and New York Heart Association (NYHA) functional class.
Nine out of 11 patients responded favorably to the treatment in group I (LVEF 39.7 ± 12.5 vs 26.0 ± 7.8%, P < 0.01; LVEDD 70.4 ± 13.6 mm vs 73.7 ± 10.5 mm, P = 0.002; NYHA class 2.2 ± 0.4 vs 3.5 ± 0.4, P < 0.01) and eight out of 12 in group II (LVEF 31.5 ± 11.5 vs 26.4 ± 8.9%, P = < 0.001; NYHA class 2.7 ± 0.4 vs 3.6 ± 0.4, P < 0.05). During the follow-up period, one patient died in group I and three in group II. There was one intraoperative LV lead dislocation in group I and one early postoperative dislocation in each group. None of the patients developed thromboembolic complications.
Our data suggest that trans-apical endocardial LV lead implantation is an alternative to epicardial LV pacing.
心外膜起搏导线植入是目前左心室（LV）导线置入的首选手术方式。对于心内膜LV起搏，我们开发了一种全新的手术方法。经心尖导线植入是一种微创技术，可进入任何LV节段。这项前瞻性随机研究的目的是比较接受经心尖心内膜或心外膜LV起搏患者的结局。
在第一组中，11例终末期心力衰竭（HF）患者（平均年龄59.7±7.9岁）接受了经心尖LV导线植入。12例终末期HF患者（第二组；平均年龄62.8±7.3岁）植入了心外膜LV导线。所有患者的药物治疗均得到优化。在18个月的随访期内比较以下参数：LV射血分数（LVEF）、LV舒张末期直径（LVEDD）、LV收缩末期直径和纽约心脏协会（NYHA）功能分级。
第一组11例患者中有9例对治疗反应良好（LVEF 39.7±12.5%对26.0±7.8%，P<0.01；LVEDD 70.4±13.6 mm对73.7±10.5 mm，P = 0.002；NYHA分级2.2±0.4对3.5±0.4，P<0.01），第二组12例中有8例（LVEF 31.5±11.5%对26.4±8.9%，P =<0.001；NYHA分级2.7±0.4对3.6±0.4，P<0.05）。在随访期间，第一组有1例患者死亡，第二组有3例。第一组有1例术中LV导线脱位，每组各有1例术后早期脱位。所有患者均未发生血栓栓塞并发症。
我们的数据表明，经心尖心内膜LV导线植入是心外膜LV起搏的一种替代方法。
