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目的冠心病患者的心肌均存在不同程度的心肌纤维化。纤维瘢痕形成后可出现心肌电传导障碍,本文结合具体5例心室电极重置的冠心病患者,来探讨冠心病患者合适的起搏部位。方法分析5例具有永久性心脏起搏器植入适应证,同时又有多年冠心病病史的患者,置入翼状电极至右室心尖部后,短时间内发生起搏及感知功能障碍,重新置入螺旋电极至右室流出道间隔部,观察其前后的起搏及感知功能。结果 5例右室流出道间隔部起搏的起搏阈值较右室心尖部起搏显著降低[(0.8±0.1)V vs(6.7±1.6)V],感知阈值显著升高[(8.6±2.5)mV vs(3.0±1.2)mV],阻抗无明显差异。随访1年无明显电极脱位,起搏和感知功能良好。结论冠心病右室心尖部达不到理想起搏阈值的患者,借助于螺旋电极放置到右室流出道间隔部可获得理想的起搏阈值。右室流出道间隔部可以作为冠心病患者合适的起搏部位。
Objective To study the changes of myocardial fibrosis in patients with coronary heart disease. Cardiac electrical conduction barriers may occur after the formation of fibrous scars. In this paper, specific 5 cases of patients with coronary heart disease with ventricular electrode replacement were investigated in order to explore appropriate pacing sites in patients with coronary heart disease. Methods Five patients with permanent cardiac pacemaker implantation indications and a history of coronary heart disease for many years were analyzed. Pacemaker and sensorimotorial dysfunction occurred in a short time after implantation of the wing electrode into the apex of the right ventricle. Into the spiral chamber electrode to the right ventricular outflow tract spacing, observation of its pacing and cognitive function before and after. Results The pacing threshold of right ventricular outflow tract septal pacing was significantly lower than that of right ventricular apical pacing [(0.8 ± 0.1) V vs (6.7 ± 1.6) V] ) mV vs (3.0 ± 1.2) mV], no significant difference in impedance. One year follow-up without significant electrode dislocation, pacing and sensing function is good. Conclusion Coronary heart disease in patients with right ventricular apex less than the ideal pacing threshold, with the help of spiral electrodes placed to the right ventricular outflow tract septal access threshold can be the ideal. Right ventricular outflow tract septum can be used as a suitable pacemaker in patients with coronary heart disease.