Lee Chin C, Do Khuyen, Patel Sati, Carlson Steven K, Konecny Tomas, Chang Philip M, Doshi Rahul N
Keck School of Medicine of the University of Southern California, 1510 San Pablo Street, Suite 322, Los Angeles, CA, 90033, USA.
University of Florida Health Congenital Heart Center, Gainesville, FL, USA.
J Interv Card Electrophysiol. 2019 Oct;56(1):79-89. doi: 10.1007/s10840-019-00599-8. Epub 2019 Aug 20.
Transvenous right ventricular pacing has traditionally been avoided after surgical tricuspid valve repair or replacement because of possible valvular dysfunction. Epicardial pacing has been used but it requires surgical thoracotomy and has higher lead failure rates when compared to transvenous pacing. We evaluated the lead stability and clinical outcomes in patients with isolated coronary sinus (CS) lead due to relative contraindication to transvenous pacing from prior tricuspid valve (TV) surgery.
We retrospectively examined a single-center cohort of 34 patients with TV disease and/or surgery who underwent permanent pacemaker implantation with a left ventricular CS lead as the only ventricular pacing lead (to avoid crossing the TV). The clinical outcome, echocardiographic data, and pacing thresholds were evaluated at follow-up.
We implanted 19 patients with a single-CS lead and 15 patients with dual-CS leads. The average left ventricular ejection fraction was 56 ± 13% prior to lead implantation and remained stable at 2-year follow-up. The tricuspid regurgitation remained mild at follow-up. The average lead pacing threshold was 1.2 ± 0.6 V × ms at implant and 1.1 ± 0.4 V × ms at 2-year follow-up (P = 0.39). For patients with dual-CS leads, the pacing threshold was 1.2 ± 0.7 V × ms at implant and 1.1 ± 0.5 V × ms at 2-year follow-up (P = 0.52).
The use of ventricular pacing entirely through the CS is an effective and minimally invasive method that provides stable pacing for patients with prior TV surgery in whom transvenous lead placement either is not possible or is relatively contraindicated.
由于可能出现瓣膜功能障碍，传统上在三尖瓣手术修复或置换后避免经静脉右心室起搏。已采用心外膜起搏，但与经静脉起搏相比，它需要开胸手术且导线故障率更高。我们评估了因先前三尖瓣手术导致经静脉起搏相对禁忌而植入孤立冠状窦（CS）导线患者的导线稳定性和临床结局。
我们回顾性研究了一个单中心队列，该队列中有34例患有三尖瓣疾病和/或接受过手术的患者，他们接受了永久性起搏器植入，以左心室CS导线作为唯一的心室起搏导线（以避免穿过三尖瓣）。在随访时评估临床结局、超声心动图数据和起搏阈值。
我们为19例患者植入了单CS导线，为15例患者植入了双CS导线。导线植入前左心室射血分数平均为56±13%，在2年随访时保持稳定。随访时三尖瓣反流仍为轻度。植入时平均导线起搏阈值为1.2±0.6V×ms，2年随访时为1.1±0.4V×ms（P = 0.39）。对于植入双CS导线的患者，植入时起搏阈值为1.2±0.7V×ms，2年随访时为1.1±0.5V×ms（P = 0.52）。
完全通过CS进行心室起搏是一种有效且微创的方法，可为先前接受过三尖瓣手术、无法或相对禁忌经静脉放置导线的患者提供稳定起搏。
