2187导线在左心室起搏中的应用价值Initial results with left ventricular pacemaker lead implantation using a 2187 left ventricular pacing lead
孙宝贵,张树富,章隆泉,沈法荣,汪爱虎,庄亚纯,温沁竹,何奔,金炜,张建军,庄文燕,薛吉祥
摘要(Abstract):
目的 寻找左心室电极导线的导入途经和技术要点及其在双心室起搏中的临床实用价值。方法 9例病人 ,男性 8例 ,均为药物治疗无效合并CLBBB的顽固性心力衰竭。CS造影 7例采用逆行法 ,2例采用顺行法显示CS。选择可剥脱CS导引导管和左室电极导线 (Medtronic ,2 187) ,采用左锁骨下静脉穿刺法 ,经CS将电极导线置于CS左心室属支 ,起搏左心室。结果 无论是逆行还是顺行冠状动脉造影 ,均清晰显示CS及其属支静脉。 6例病人经导引导管将 2 187导线成功导入靶静脉 ,3例病人直接导入 2 187导线。电极导线尖端 1例插进心大静脉远端 ,2例位于左室侧缘静脉 ,2例放在左室后静脉 ,4例导入左室后侧静脉。导线到位后测量的各起搏参数均符合起搏要求 ,长期随访未见导线脱位和起搏功能的变化。结论 CS顺行和逆行造影均可清晰显示CS及其属支 ;直接或经导引导管皆可将 2 187电极导线导入靶静脉 ;应用 2 187型LV电极导线经CS左心室心外膜起搏技术可行、安全可靠 ,可广泛临床应用
关键词(KeyWords): 双心室起搏;左室起搏导线;冠状静脉
基金项目(Foundation):
作者(Author): 孙宝贵,张树富,章隆泉,沈法荣,汪爱虎,庄亚纯,温沁竹,何奔,金炜,张建军,庄文燕,薛吉祥
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