机械瓣置换术后三尖瓣患者经冠状静脉窦左心室起搏的临床研究
Clinical investigation of left ventricular pacing using coronary sinus in patients with mechanical prosthetic tricuspid valve replacement.
作者信息
Zha Kelan, Cui Kaijun, Liu Xingbin, Fang Yuan
机构信息
Department of Cardiology, West China School of Medicine, Sichuan University, Chengdu, China.
Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China.
出版信息
Clin Cardiol. 2017 Nov;40(11):1139-1144. doi: 10.1002/clc.22800. Epub 2017 Nov 22.
BACKGROUND
Although transvenous right ventricular (RV) endocardial lead placement is routine practice in clinical pacing, RV inaccessibility in certain clinical situations mandates the search for other sites.
HYPOTHESIS
This study is aimed to verify whether left ventricular lead through coronary sinus is safe and efficient.
METHODS
Based on a retrospective analysis of a single-center series of 4 patients with inaccessibility for RV pacing, we report on the feasibility and reliability of coronary sinus (CS) pacing via left ventricular (LV) lead, which usually is used in cardiac resynchronization therapy. Four patients with valvular heart disease and bradycardias post-mechanical prosthetic tricuspid valve replacement were studied. The LV leads were implanted into the lateral vein or great cardiac vein of the CS, and all parameters were programmed postprocedure.
RESULTS
In all cases procedures yielded favorable parameters, with 1 CS dissection. At long-term follow-up, there was no threshold increase or lead dislocation.
CONCLUSIONS
LV lead implantation through the CS appears safe and efficacious in patients with inaccessibility for RV pacing.
背景
尽管经静脉右心室心内膜起搏导线置入是临床起搏的常规操作，但在某些临床情况下右心室难以触及，这就需要寻找其他部位。
假说
本研究旨在验证经冠状窦置入左心室起搏导线是否安全有效。
方法
基于对单中心4例无法进行右心室起搏患者的回顾性分析，我们报告了通常用于心脏再同步治疗的经左心室起搏导线进行冠状窦起搏的可行性和可靠性。研究了4例瓣膜性心脏病患者，这些患者在机械性人工三尖瓣置换术后出现心动过缓。将左心室起搏导线植入冠状窦的外侧静脉或心大静脉，并在术后对所有参数进行程控。
结果
所有病例的手术均获得了良好的参数，1例出现冠状窦夹层。长期随访时，起搏阈值无升高，导线无脱位。
结论
对于无法进行右心室起搏的患者，经冠状窦植入左心室起搏导线似乎是安全有效的。
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