Sideris Skevos, Drakopoulou Maria, Oikonomopoulos George, Gatzoulis Konstantinos, Stavropoulos George, Limperiadis Dimitris, Toutouzas Konstantinos, Tousoulis Dimitris, Kallikazaros Ioannis
Cardiology Department, Hippokration Hospital, Athens, Greece.
First Department of Cardiology, Hippokration Hospital, Athens Medical School, Athens, Greece.
Pacing Clin Electrophysiol. 2016 Apr;39(4):378-81. doi: 10.1111/pace.12815. Epub 2016 Feb 18.
In the presence of tricuspid valve intervention, right ventricular lead implantation is associated with the potential risk of tricuspid valve malfunction leading to a tricuspid regurgitation. Few cases have been reported with successful left ventricular pacing via the coronary sinus (CS) after tricuspid valve replacement or repair. In this retrospective study, we present the long-term clinical outcomes of 17 patients who underwent CS lead implantation and left ventricular pacing.
Seventeen consecutive patients referred to our institution with an indication of postprocedural pacemaker (PM) implantation after tricuspid valve intervention were retrospectively included in the study. The indication for device implantation in all patients was atrial fibrillation with a symptomatic pause ≥ 3.0 seconds. Thus, all devices implanted were ventricular rate responsive (VVIR).
All device implantations were successful and uncomplicated. Mean operation time was 60 ± 8 minutes. Mean fluoroscopy time was 8.3 ± 2.1 minutes. Mean R-wave sensing was 7.5 ± 2.0 mV with a mean slew rate of 2.2 V/s. A mean pacing threshold of 1.9 ± 0.3 V/0.4 ms was accepted as patients were not PM-dependent. The pacing impedance was 743.5 ± 109.71 Ohm. At 2-year follow-up, pacing sensing, threshold, and impedance values were unchanged and no lead dislodgement has been noted.
In patients with tricuspid valve intervention, left ventricular pacing might be the treatment of choice for permanent ventricular pacing, with all the advantages of the endovenous route as a minimally invasive approach.
在进行三尖瓣干预时，右心室导线植入与三尖瓣功能障碍导致三尖瓣反流的潜在风险相关。三尖瓣置换或修复后经冠状窦（CS）成功进行左心室起搏的病例报道较少。在这项回顾性研究中，我们展示了17例接受CS导线植入和左心室起搏患者的长期临床结果。
本研究回顾性纳入了17例因三尖瓣干预后有植入起搏器（PM）指征而转诊至我院的连续患者。所有患者植入装置的指征均为房颤且有症状性停搏≥3.0秒。因此，所有植入的装置均为心室率应答型（VVIR）。
所有装置植入均成功且无并发症。平均手术时间为60±8分钟。平均透视时间为8.3±2.1分钟。平均R波感知为7.5±2.0 mV，平均 slew 率为2.2 V/s。由于患者不依赖PM，平均起搏阈值为1.9±0.3 V/0.4 ms被接受。起搏阻抗为743.5±109.71欧姆。在2年随访时，起搏感知、阈值和阻抗值未改变，且未发现导线脱位。
对于接受三尖瓣干预的患者，左心室起搏可能是永久性心室起搏的首选治疗方法，具有静脉内途径作为微创方法的所有优点。
