病例报告：一例单腔植入式心脏复律除颤器患者发生膈神经刺激的罕见病例。
Case report: An unusual case of phrenic nerve stimulation in a patient with single chamber implantable cardioverter defibrillator.
作者信息
De Innocentiis Carlo, Astore Pasquale, Buonpane Angela, Santamaria Antonia Pia, Patragnoni Francesco, Santamaria Matteo
机构信息
Arrhythmology and Electrophysiology Unit, Gemelli Molise Hospital, Campobasso, CB, Italy.
Agostino Gemelli IRCCS University Hospital Foundation, Rome, Italy.
出版信息
Front Cardiovasc Med. 2023 Feb 23;10:1088697. doi: 10.3389/fcvm.2023.1088697. eCollection 2023.
BACKGROUND
Phrenic nerve stimulation is a well-recognized complication related to cardiac implantable electronic devices, in particular with left ventricular coronary sinus pacing leads for cardiac resynchronization therapy.
CASE PRESENTATION
We report an unusual case of symptomatic phrenic nerve stimulation due to inadvertent placement of a right ventricular defibrillation lead in coronary sinus posterior branch in a patient with heart failure with reduced ejection fraction with a recently implanted single-chamber cardioverter defibrillator.
DISCUSSION
Phrenic nerve stimulation is a relatively common complication of left ventricular pacing. Inadvertent placement of a right ventricular lead in a coronary sinus branch is a rare but possible cause of phrenic nerve stimulation. Careful evaluation of intraprocedural fluoroscopic and electrocardiographic appearance of pacing and defibrillation leads during implantation may prevent inadvertent placement of a right ventricular lead in the coronary sinus.
背景
膈神经刺激是一种与心脏植入式电子设备相关的公认并发症，尤其是在用于心脏再同步治疗的左心室冠状窦起搏导线方面。
病例报告
我们报告了一例不寻常的有症状膈神经刺激病例，该病例发生在一名射血分数降低的心力衰竭患者中，其近期植入了单腔心脏复律除颤器，因右心室除颤导线意外放置在冠状窦后分支所致。
讨论
膈神经刺激是左心室起搏相对常见的并发症。右心室导线意外放置在冠状窦分支是膈神经刺激的一种罕见但可能的原因。在植入过程中仔细评估起搏和除颤导线的术中透视及心电图表现，可能会防止右心室导线意外放置在冠状窦中。
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