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目的应用外科植入左室起搏电极进行心脏再同步化治疗心衰,并报道1例双腔起搏器植入患者改为左室心外膜电极植入的方法。方法总结两个心脏中心临床经验,对介入冠状静脉窦左室电极植入失败患者进行外科植入左室心外膜电极。结果所有患者随访均存活,无手术相关并发症,患者心功能得以改善,平均LVEF从术前的(32.7±5.5)%提高到(39.2±8.1)%,左室舒张末直径缩小。结论通过改进外科技术,起搏电极导线的植入点可在侧后壁进行选择,从而能更好地改善血流动力学,起搏电极导线脱位和膈神经刺激的发生率较小。
Objective To apply surgical implantation of left ventricular pacing electrodes for cardiac resynchronization in the treatment of heart failure and to report the method of implanting left ventricular epicardial electrodes in 1 patient with dual-chamber pacemaker implantation. Methods The clinical experiences of two heart centers were summarized. Left ventricular epicardial electrodes were implanted surgically in patients with coronary sinus ventricular left ventricular failure. Results All the patients were followed up for survival. There was no complications related to surgery. The patients’ heart function improved. The mean LVEF increased from (32.7 ± 5.5)% to (39.2 ± 8.1)% and the diameter of left ventricular end diastole decreased. Conclusions By improving the surgical technique, placement of the pacemaker lead can be selected at the posterior wall to better improve hemodynamics with less incidence of pacing lead and phrenic nerve stimulation.