[1]熊峰 邓晓奇 谭焜月 王淑珍 刘春霞 张丽娟.经胸超声心动图引导左束支区域起搏电极植入的初步评价[J].心血管病学进展,2019,(9):1312-1319.[doi:10.16806/j.cnki.issn.1004-3934.2019.09.033]
　XIONG FengDENG XiaoqiTAN kunyueWANG ShuzhenLIU ChunxiaZHANG Lijuan.Preliminary Evaluation of Transthoracic Echocardiography for Pacemaker Electrode Implantation in the Left Bundle Branch[J].Advances in Cardiovascular Diseases,2019,(9):1312-1319.[doi:10.16806/j.cnki.issn.1004-3934.2019.09.033]
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经胸超声心动图引导左束支区域起搏电极植入的初步评价()
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《心血管病学进展》[ISSN:51-1187/R/CN:1004-3934]

卷:
期数:
2019年9期
页码:
1312-1319
栏目:
论著
出版日期:
2019-12-25

文章信息/Info

Title:
Preliminary Evaluation of Transthoracic Echocardiography for Pacemaker Electrode Implantation in the Left Bundle Branch
作者:
熊峰 邓晓奇 谭焜月 王淑珍 刘春霞 张丽娟
 (西南交通大学附属医院 成都市第三人民医院心内科 成都市心血管病研究所,四川 成都 610031 )
Author(s):
XIONG FengDENG XiaoqiTAN kunyueWANG ShuzhenLIU ChunxiaZHANG Lijuan
(Department of Cardiology, Chengdu Third People’s Hospital, Affiliated Hospital of Southwest Jiaotong University, Chengdu Institute of Cardiovascular Diseases, Chengdu 610031, Sichuan, China)
关键词:
经胸超声心动图; 左束支; 心脏起搏; 电极植入
Keywords:
Transthoracic echocardiography; Left bundle branch; Cardiac pacing; Electrode implantation
DOI:
10.16806/j.cnki.issn.1004-3934.2019.09.033
摘要:
目的 探讨经胸超声心动图在左束支区域起搏术中引导电极植入的方法及作用。方法 2019年7月—2019年8月在我院行左束支区域起搏的5例患者，术前经胸超声心动图拟定电极植入区域（靶区域）及植入路径。术中经胸超声心动图实时引导电极植入靶区域及植入深度，记录心电图特征、起搏参数、手术时间、X线曝光时间。结果 5例患者皆成功在经胸超声心动图实时引导下实施左束支区域起搏，4例电极植入靶区域，1例电极植入低于靶区域。其中1例患者电极穿孔入左心室，更换区域植入。5例患者手术时间（125.00±8.12）min，X线曝光时间（14.16±1.68）min，心室电极植入时间（24.80±7.01）min，心室电极植入X线曝光时间（8.93±1.84）min。术后1周、1个月、3个月随访起搏参数稳定，无导线脱位、穿孔、血栓及感染发生。结论 经胸超声心动图可引导左束支区域起搏术中电极植入，避免电极植入深度不足及电极穿孔等并发症发生。靶区域的制定，有利于促进左束支区域起搏术式的操作统一。
Abstract:
Objective To explore the effect of transthoracic echocardiography(TTE) for guiding electrode implantation in left bundle branch pacing. Methods Five patients in our hospital from July 2019 to August 2019 underwent TTE to determine the electrode implantation area (target area) and implantation path before operation. TTE guided real-time electrode implantation target area and implantation depth.The electrocardiogram(ECG) characteristics, pacing parameters, operation time, and X-ray exposure time were recorded. Results Left bundle branch pacing was successfully performed in all 5 patients under the real-time guidance of transthoracic echocardiography. the electrode was implanted in the target area in 4 cases and lower than the target area in 1 case. In one patient, the electrode was perforated into the left ventricle and the replacement area was implanted. The operation time of 5 patients was (125.00±8.12) min, X-ray exposure time (14.16±1.68) min, ventricular electrode implantation time (24.80±7.01) min, ventricular electrode implantation X-ray exposure time (8.93±1.84) min. The pacing parameters were stable at 1 week, 1 month and 3 months after operation, and there was no wire dislocation, perforation, thrombosis and infection.Conclusion TTE can guide electrode implantation in left bundle branch area pacing and avoid complications such as insufficient depth of electrode implantation and electrode perforation. The establishment of the target area is beneficial to promote the unity of pacing operation in the left bundle branch area

参考文献/References:


[1] Huang W,Su L,Wu S,et al.Benefits of permanent his bundle pacing combined with atrioventricular node ablation in atrial fibrillation patients with heart failure with both preserved and reduced ventricular ejection fraction[J].J Am Heart Assoc,2017,6(4): 1-11.

[2] 李玉秋,陈柯萍.左束支起搏的现状与困惑[J].南京医科大学学报(自然科学版),2019,39(6):793-796.

[3] James TN,Sherf L,Urthaler F. Fine structure of the bundle branches[J]. Br Heart J,1974,36(1):1-18.

[4] Sweeney MO, Hellkamp AS, Ellenbogen KA, et al. Adverse effect of ventricular pacing on heart failure and atrial fibrillation among patients with normal baseline QRS duration in a clinical trial of pace maker therapy for sinus node dysfunction[J]. Circulation,2003,107(23): 2932-2937.

[5] Wilkoff BL, Cook JR, Epstein AE, et al. Dual-chamber pacing or ventricular backup pacing in patients with an implantable defibrillator: the dual chamber and VVI implantable defibrillator (DAVID) trial[J]. JAMA,2002,288(24):3115-3123.

[6] Abdelrahman M, Subzposh FA, Beer D, et al. Clinical outcomes of his bundle pacing compared to right ventricular pacing[J]. J Am Coll Cardiol,2018,71(20): 2319-2330.

[7] Qian Z,Zou F,Wang Y,et al. Perment his bundle pacing in heart failure patients:a systematic review ane meta-analysis[J]. Pacing Clin Electrophysiol,2019,42(2): 139-145.

[8] Mafi-Rad M,Luermans JG,Blaauw Y,et al. Feasibility and acute hemodynamic effect of left ventricular septal pacing by transvenous approach through the interventricular septum[J]. Circ Arrhythm Electrophysiol,2016,9(3):e003344.

[9] Massing GK,James TN.Anatomical configuration of the his bundle and bundle branches in the human heart[J].Ciculation,1976,53(4):609-621.

[10] 匡晓晖,张曦,高晓龙,等.心腔内超声指导左束支起搏[J].中华心律失常学杂志,2019,23(2):109-114.

[11] Chen K,Li Y,Dai Y,et al.Comparison of electrocardiogram characteristics and pacing parameters between left bundle branch pacing and right ventricular pacing in patients receiving pacemaker therapy[J].Europace,2019,21(4):673-680.

[12] Tse HF,Yu C,Wong KK,et al.Functional abnormalities in patients with permanent right ventricular pacing：the effects of sites of electrical stimulation[J].J Am Coll Cardiol, 2002,40(8):1451.

[13] 曾春苗,彭双林,阮天成.左束支区域起搏对房室传导阻滞患者近期疗效及安全性的评估[J].广东医科大学学报,2019,37(1):41-44.

[14] Su L,Wu S,Wang S,et al. Pacing paramenters and success rates of permanent His-Bundle pacing in patients with narrow QRS:a single-centre experience[J]. Europace,2019,21(5):763-770.

相似文献/References:

[1]邓晓奇 汪汉 秦淑娟 刘汉雄 童琳 蔡琳.左束支起搏心电图的特点观察[J].心血管病学进展,2020,(1):93.[doi:10.16806/j.cnki.issn.1004-3934.2020.01.025]
　DENG Xiaoqi,WANG Han,QIN Shujuan,et al.Characteristics of Electrocardiogram in Left Bundle Branch Pacing[J].Advances in Cardiovascular Diseases,2020,(9):93.[doi:10.16806/j.cnki.issn.1004-3934.2020.01.025]

更新日期/Last Update: 2020-02-06