Higgins Steven L
Department of Cardiology, Scripps Memorial Hospital, La Jolla, CA.
J Innov Card Rhythm Manag. 2017 Jul 15;8(7):2784-2789. doi: 10.19102/icrm.2017.080702. eCollection 2017 Jul.
Cardiac resynchronization therapy (CRT) has been demonstrated to improve symptoms of heart failure. As a result, it has become the standard of care in selected patients, and is commonly completed with three leads placed via an upper-extremity vein. However, in rare situations, such as in the case of superior vena cava occlusion, venous access is not possible via the upper extremity. It is in such instances that alternative means must be sought. Here, two patients who received a CRT defibrillator via an iliac vein approach with a mid-abdominal generator are introduced, and a review of the techniques used is presented. Technical aspects to this approach are discussed, including iliac venous access, defibrillation electrode positioning, coronary sinus access, and lead tunneling to an abdominal generator for patient comfort. This approach should be considered when vascular access is compromised, at least until combined leadless CRT pacing and subcutaneous implantable cardioverter-defibrillator devices become available and feasible for use.
心脏再同步治疗（CRT）已被证明可改善心力衰竭症状。因此，它已成为特定患者的标准治疗方法，通常通过上肢静脉放置三根导线来完成。然而，在罕见情况下，如在 Superior vena cava occlusion（上腔静脉阻塞）的病例中，无法通过上肢进行静脉通路。正是在这种情况下，必须寻求替代方法。在此，介绍了两名通过髂静脉途径使用腹部中部发生器接受CRT除颤器的患者，并对所使用的技术进行了综述。讨论了该方法的技术方面，包括髂静脉通路、除颤电极定位、冠状窦通路以及为了患者舒适将导线引入腹部发生器。当血管通路受损时，应考虑这种方法，至少直到联合无导线CRT起搏和皮下植入式心律转复除颤器设备可用且可行使用为止。
