Kean Adam C, Kay W Aaron, Patel Jyoti K, Miller John M, Dandamudi Gopi
Division of Pediatric Cardiology, Department of Pediatrics, Pediatric Electrophysiology, Indiana University School of Medicine, Indianapolis, IN.
Division of Cardiology, Department of Internal Medicine, Indiana University School of Medicine, Director, Adult Congenital Heart Disease Program, Krannert Institute of Cardiology.
Pacing Clin Electrophysiol. 2017 Nov;40(11):1313-1317. doi: 10.1111/pace.13107. Epub 2017 Jun 30.
We report the placement of a permanent transvenous nonselective His bundle pacing lead in conjunction with a transvenous pacemaker/implantable cardioverter-defibrillator in an adult with Levo-Transposition of the Great Arteries (L-TGA) and a stenotic coronary sinus (CS) ostium, which would not accommodate a transvenous left ventricular (LV) pacing lead. Nonselective His bundle pacing provided a nearly identical ventricular activation pattern in this previously unpaced patient. Many L-TGA patients will have an eventual need for permanent pacing and, given the challenges of CS cannulation, His bundle pacing may represent a preferred modality rather than pure morphologic LV pacing or surgical systemic ventricular lead placement to achieve optimal electrical synchrony.
我们报告了在一名患有大动脉左旋转位（L-TGA）和狭窄冠状静脉窦（CS）口且无法容纳经静脉左心室（LV）起搏导线的成人患者中，将永久性经静脉非选择性希氏束起搏导线与经静脉起搏器/植入式心律转复除颤器联合植入的情况。在这名之前未进行起搏治疗的患者中，非选择性希氏束起搏提供了几乎相同的心室激动模式。许多L-TGA患者最终将需要永久性起搏，鉴于CS插管的挑战，希氏束起搏可能是一种更优的方式，而非单纯基于形态学进行LV起搏或通过手术放置全身心室导线来实现最佳电同步。
