Vado Antonello, Menardi Endrj, Rossetti Guido, Ballari Gianpaolo, Feola Mauro, Bobbio Marco
EP Lab, Ospedale S.Croce e Carle, Via Coppino 26, 12100, Cuneo, Italy,
J Interv Card Electrophysiol. 2014 Mar;39(2):161-5. doi: 10.1007/s10840-013-9849-8. Epub 2013 Nov 29.
Recent studies have shown that a quadripolar left ventricular (LV) lead can result in low rates of dislocation and phrenic nerve stimulation (PNS) acutely and on medium-term follow-up in cardiac resynchronization therapy (CRT). We evaluated the outcomes of CRT patients in whom a quadripolar LV lead was implanted in our institution.
We studied 45 consecutive heart failure patients (75 % men; age, 70.3 ± 9.0 years) following successful implantation of a quadripolar LV lead. Demographic and clinical data were collected preoperatively, and patients were followed up for 18.9 months.
The implantation success rate was 100 %. Mean overall duration was 100.1 ± 34.6 min, and X-ray exposure time was 13.20 ± 13.5 min. The most distal effective pacing site was used as the final pacing configuration in all patients. Acute dislodgment requiring reoperation occurred before discharge in three cases (6.6 %). Six patients (13 %) suffered PNS during follow-up; we solved this problem by changing the stimulation vector. Three months after implantation, a mean of six out of ten effective sites (threshold <2.5 V at 1.5 ms, no PNS) per patient was recorded.
Over the relatively long term, the quadripolar LV lead was associated with excellent pacing thresholds and low rates of dislocation and PNS.
近期研究表明，在心脏再同步治疗（CRT）中，四极左心室（LV）导线在急性和中期随访时可导致较低的脱位率和膈神经刺激（PNS）发生率。我们评估了在我们机构植入四极LV导线的CRT患者的治疗结果。
我们研究了45例连续的心力衰竭患者（75%为男性；年龄70.3±9.0岁），这些患者成功植入了四极LV导线。术前收集人口统计学和临床数据，并对患者进行了18.9个月的随访。
植入成功率为100%。平均总时长为100.1±34.6分钟，X线暴露时间为13.20±13.5分钟。所有患者均将最远端有效起搏部位用作最终起搏配置。3例患者（6.6%）在出院前发生急性脱位需要再次手术。6例患者（13%）在随访期间出现PNS；我们通过改变刺激向量解决了这个问题。植入后3个月，每位患者平均记录到十个有效部位中的六个（在1.5毫秒时阈值<2.5V，无PNS）。
在相对较长的时间内，四极LV导线具有出色的起搏阈值以及较低的脱位率和PNS发生率。
