Cardiovascular Division, Washington University, School of Medicine, 660 S. Euclid Ave, Campus Box 8086, St. Louis, MO, USA.
Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA.
Europace. 2018 Apr 1;20(4):636-642. doi: 10.1093/europace/euw422.
To evaluate coronary sinus single-site (CSSS) left ventricular pacing in adult patients with normal left ventricular ejection fraction (LVEF) when traditional right ventricular lead implantation is not feasible or is contraindicated.
We performed a retrospective analysis of 23 patients with tricuspid valve surgery/disease who received a CSSS ventricular pacing lead to avoid crossing the tricuspid valve. Two matched control populations were obtained from patients receiving (i) conventional right ventricular single-site (RVSS) leads and (ii) coronary sinus leads for cardiac resynchronization therapy (CSCRT). Main outcomes of interest were lead stability, electrical lead parameters and change in LVEF during long-term follow-up. Successful CSSS pacing was accomplished in all 23 patients without any procedural complications. During the 5.3 ± 2.8-year follow-up 22/23 (95.7%) leads were functional with stable pacing and sensing parameters, and 1/23 (4.3%) was extracted for unrelated reasons. Compared to CSSS leads, the lead revision/abandonment was similar with RVSS leads (Hazard ratio (HR) 0.87, 95% confidence interval (CI) 0.03, 22.0), but was higher with CSCRT leads (HR 7.41, 95% CI 1.30, 139.0). There was no difference in change in LVEF between CSSS and RVSS groups (-2.4 ± 11.0 vs. 1.5 ± 12.8, P = 0.76), but LVEF improved in CSCRT group (11.2 ± 16.5%, P = 0.002). Fluoroscopy times were longer during implantation of CSSS compared to RVSS leads (25.6 ± 24.6 min vs. 12.3 ± 18.6 min, P = 0.049).
In patients with normal LVEF, single-site ventricular pacing via the coronary sinus is a feasible, safe and reliable alternative to right ventricular pacing.
评估在传统右心室导联植入不可行或禁忌的情况下，正常左心室射血分数（LVEF）的成年患者行冠状窦单部位（CSSS）左心室起搏的效果。
我们对 23 例因三尖瓣疾病/手术而行 CSSS 心室起搏导联植入以避免跨瓣的患者进行了回顾性分析。从接受（i）传统右心室单部位（RVSS）导联和（ii）心脏再同步治疗（CSCRT）冠状窦导联的患者中获得了 2 个匹配的对照组。主要观察终点是导线稳定性、电导线参数和长期随访期间 LVEF 的变化。23 例患者均成功完成 CSSS 起搏，无任何手术并发症。在 5.3±2.8 年的随访中，22/23（95.7%）的导联功能稳定，起搏和感知参数正常，1/23（4.3%）因非相关原因取出。与 CSSS 导联相比，RVSS 导联的导线修订/废弃率相似（风险比（HR）0.87，95%置信区间（CI）0.03，22.0），但 CSCRT 导联更高（HR 7.41，95%CI 1.30，139.0）。CSSS 和 RVSS 组之间 LVEF 的变化没有差异（-2.4±11.0 与 1.5±12.8，P=0.76），但 CSCRT 组 LVEF 改善（11.2±16.5%，P=0.002）。与 RVSS 导联相比，CSSS 导联植入时透视时间更长（25.6±24.6 分钟与 12.3±18.6 分钟，P=0.049）。
在 LVEF 正常的患者中，经冠状窦行单部位心室起搏是一种可行、安全和可靠的右心室起搏替代方法。
