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右室永久起搏可行的后备电极放置部位 右室流出道 |
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祁述善 沈向前 周胜华 刘剑波
摘要 为探讨冠心病心肌纤维化、合并糖尿病或恶性肿瘤放射治疗后出现房室阻滞的患者右室永久起搏可行的后备电极放置部位，对3例电极脱位至右室流出道、9例因上述疾病主动将电极置入右室流出道的患者进行了起搏阈值测定及随访。结果：12例患者右室流出道起搏阈值（电压：0.86±0.10 V,脉宽：0.3±0.04 ms）较右室心尖部起搏阈值（电压：5.0±6.06 V，脉宽：1.52±0.77 ms）显著降低，P<0.01。随访68.5±34.65个月无电极脱位，起搏功能良好。结果提示右室流出道是永久起搏可行的后备电极放置部位。
关键词 右室起搏，永久 右室流出道 起搏部位
Right Ventricular Outflow Tract as An Alternative Permanent Pacing Site
Qi Shushan,Shen Xiangqian,Zhou Shenghua,et al
(Department of Cardiology,the Second Affiliated Hospital of Hunan Medical
University,Changsha,410011)
Abstract In patients with myocardial fibrosis type of coronary heart disease,especially complicating diabetes mellitus or combined radiation therapy for treatment of malign tumor,during cardiac pacing,pacing threshold in some cases is increasing significantly.For investigating an alternative permanent pacing site in right ventricular outflow tract (RVOT)to the right ventricular apex,in 12 such patients,permanent pacing electrode (straight tined endocardial lead and programmable pacemaker)was inserted onto the RVOT(including disloged pacemaker electrode reimplanted onto the RVOT in 3 cases).The result showed that the pacing threshold on RVOT in pulse amplitude was 0.86±0.1 V,in pulse width was 0.3±0.04 ms; but in right ventricular apex,the pulse amplitude was 5.0±6.06 V,in pulse width was 1.52±0.77 ms(both pulse amplitude and pulse width,P<0.01).In long-term follow-up(68.5±34.65 months),it showed that there was no electrode dislogement,a good pacing condition had been maintained.It is considered that RVOT as an alternative permanent pacing site is highly satisfactory.
Key words Right ventricular pacing,permanent Right ventricular outflow tract Pacing site
冠心病心肌纤维化尤其是合并糖尿病或恶性肿瘤行放射治疗后的患者，若出现严重的房室阻滞行右室永久起搏治疗，在右室心尖部置入起搏电极，可能会出现起搏阈值增高及感知不良现象［1，2］。为探讨这类病人满意的右室起搏部[1] [2] 下一页
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