Otsuka Yosuke, Okamura Hideo, Sato Syunsuke, Nakajima Ikutaro, Ishibashi Kohei, Miyamoto Kouji, Noda Takashi, Aiba Takeshi, Kamakura Shiro, Kobayashi Junjiro, Yasuda Satoshi, Ogawa Hisao, Kusano Kengo
Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka 5658565, Japan.
Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka 5658565, Japan ; Department of Advanced Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Japan.
J Arrhythm. 2015 Jun;31(3):159-62. doi: 10.1016/j.joa.2014.09.003. Epub 2014 Oct 22.
A 65-year-old woman with a history of syncope was diagnosed with hypertrophic cardiomyopathy. She had previously undergone mastectomy of the left breast owing to breast cancer. Holter electrocardiogram (ECG) and monitor ECG revealed sick sinus syndrome (Type II) and non-sustained ventricular tachycardia. Sustained ventricular tachycardia and ventricular fibrillation were induced in an electrophysiological study. Although the patient was eligible for treatment with a dual chamber implantable cardioverter defibrillator (ICD), venography revealed lack of the right superior vena cava (R-SVC). Lead placement from the left subclavian vein would have increased the risk of lymphedema owing to the patient׳s mastectomy history. Consequently, the defibrillation lead was placed in the right ventricle by direct puncture of the right auricle through the tricuspid valve. The atrial lead was sutured to the atrial wall, and the postoperative course was unremarkable. Defibrillation lead placement using a transthoracic transatrial approach can be an alternative method in cases where a transvenous approach for lead placement is not feasible.
一名有晕厥病史的65岁女性被诊断为肥厚型心肌病。她曾因乳腺癌接受过左乳切除术。动态心电图（ECG）和监测心电图显示病态窦房结综合征（II型）和非持续性室性心动过速。在电生理研究中诱发出持续性室性心动过速和心室颤动。尽管该患者符合双腔植入式心脏复律除颤器（ICD）治疗条件，但静脉造影显示右上腔静脉（R-SVC）缺如。由于患者有乳房切除病史，从左锁骨下静脉放置电极导线会增加淋巴水肿的风险。因此，通过经三尖瓣直接穿刺右心耳将除颤电极导线置于右心室。心房电极导线缝合至心房壁，术后过程顺利。在经静脉放置电极导线不可行的情况下，经胸经心房途径放置除颤电极导线可能是一种替代方法。
