Kamalzadeh Hassan, Yazdani Shahrooz, Jalali Mohammad
Shahid Rajaei Hospital, Alborz University of Medical Sciences, Karaj, Iran.
J Tehran Heart Cent. 2018 Jan;13(1):27-31.
In patients with cardiac resynchronization therapy (CRT), loss of left ventricular (LV) stimulation occurs chiefly because of LV lead dislodgement. The occurrence rate of LV lead dislodgement in different reports is between 2% and 12% of patients. LV lead dislodgement precludes clinical improvement. We describe 2 patients with heart failure, fulfilling the criteria for CRT implantation. In both patients, right ventricular and right atrial leads were implanted via the left subclavian vein in the right ventricular apex and the right atrial appendage, respectively. Repeated LV lead implantation was unsuccessful and each time after the fixation, the LV lead was dislodged with the heart motion during systole and diastole. In order to stabilize the LV lead, we decided to benefit from coronary sinus stenting and lead entrapment behind the deployed stent. LV lead stabilization was accomplished by the deployment of bare-metal stents (Multi-Link 3.5 × 8 mm and Multi-Link 3 × 8 mm, Abbott Vascular) in order to entrap the LV lead. The stents were deployed at a nominal pressure (10 atm). The pacing performance of the LV leads was satisfactory and stable at midterm in our experience. Stenting within the coronary sinus seems to be a safe method for LV lead stabilization and can substantially boost the success rate of CRT. Our device analysis during short- and midterm follow-up (4 months after implantation) revealed acceptable LV lead threshold and impedance.
在接受心脏再同步治疗（CRT）的患者中，左心室（LV）刺激丧失主要是由于LV导联脱位所致。不同报告中LV导联脱位的发生率在患者总数的2%至12%之间。LV导联脱位会妨碍临床症状改善。我们描述了2例符合CRT植入标准的心力衰竭患者。在这2例患者中，右心室和右心房导联分别经左锁骨下静脉植入右心室心尖部和右心耳。多次LV导联植入均未成功，每次固定后，LV导联在心脏收缩期和舒张期运动时都会脱位。为了稳定LV导联，我们决定利用冠状静脉窦支架置入术并将导联固定在已置入的支架后方。通过置入裸金属支架（雅培血管公司的Multi-Link 3.5×8 mm和Multi-Link 3×8 mm）来固定LV导联，从而实现了LV导联的稳定。支架以标称压力（10个大气压）置入。根据我们的经验，LV导联的起搏性能在中期令人满意且稳定。冠状静脉窦内支架置入术似乎是一种稳定LV导联的安全方法，并且可以显著提高CRT的成功率。我们在短期和中期随访（植入后4个月）期间进行的设备分析显示，LV导联阈值和阻抗均可接受。
