Blanc J J, Benditt D G, Gilard M, Etienne Y, Mansourati J, Lurie K G
Department of Cardiology, Brest University-Hospital, France.
Pacing Clin Electrophysiol. 1998 Nov;21(11 Pt 1):2021-4. doi: 10.1111/j.1540-8159.1998.tb01119.x.
LV-based pacing has recently been reported to be of benefit in patients with severe cardiac failure and left bundle branch block. LV permanent pacing has been reported using epicardial leads but the surgical mortality is excessive. A transvenous approach is now favored. In this regard, cannulation of the coronary sinus and of one of its tributaries using only the permanent electrode is feasible but technically challenging. We describe a "long guiding sheath" method using catheterization, and a long radiopaque and peelable sheath. Once the coronary sinus is cannulated with the electrophysiological catheter, the long sheath is advanced to the mid-part of the coronary sinus. The permanent pacing electrode is then placed through the sheath and into a tributary of the coronary sinus. This method has been attempted in 10 patients and was successful in 8, with an average lead insertion time of 21 +/- 5.5 minutes and an average fluoroscopic time of 11 +/- 5.5 minutes. In conclusion, although transvenous left ventricular pacing remains a challenge, the "long guiding sheath" approach appears to facilitate this procedure with both a high success rate and an acceptable procedure time.
最近有报道称，基于左心室的起搏对严重心力衰竭和左束支传导阻滞患者有益。已有使用心外膜导线进行左心室永久起搏的报道，但手术死亡率过高。目前更倾向于经静脉途径。在这方面，仅使用永久电极对冠状窦及其一条分支进行插管是可行的，但技术上具有挑战性。我们描述了一种使用导管插入术以及不透射线的可剥离长鞘管的“长引导鞘管”方法。一旦用电生理导管插入冠状窦，将长鞘管推进到冠状窦中部。然后将永久起搏电极通过鞘管置入冠状窦的一条分支。该方法已在10例患者中尝试，8例成功，平均导线插入时间为21±5.5分钟，平均透视时间为11±5.5分钟。总之，尽管经静脉左心室起搏仍然是一项挑战，但“长引导鞘管”方法似乎能以高成功率和可接受的手术时间促进这一操作。
