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目的为了解决锁骨下静脉闭塞患者和年幼儿童使用植入型心律转复除颤器(ICD)的困难,本研究旨在评价皮下卷绕除颤(SubQ)电极的可行性及其除颤效果。方法共4例病人纳入研究。年龄分别63、64、85、48岁。其中3例男性患者基础心脏病为冠心病、1例女性(48岁)为扩张性心肌病。患者病史有室性心动过速(室速)、心室颤动(室颤)或电生理检查中诱发持续性室速。SubQ电极经左腋中线第6肋间的2cm纵向切口建立的皮下隧道远端送达靠近脊柱,电极近端经向前向上的另一皮下隧道抵达左锁骨下放置ICD的囊袋。模拟活性除颤器机壳(CAN)经左锁骨下ICD放置囊袋切口于胸大肌与胸壁之间的隧道向下送至接近胸骨下端左侧。CAN与SubQ电极之间除颤测试能量依次分别为35、25和15J。测试完毕后3例患者按照常规方法植入ICD。另1例患者因为左心室射血分数低于0.35而植入三腔除颤器(CRT-D)。所有患者保留SubQ电极,手术结束前对它们的除颤阈值进行测试。使用能量先后依次为3、6、10、12、15和18J。结果所有患者顺利度过植入术,无并发症。4例患者的X线曝光时间分别为37、20、9和52min。4例CAN→SubQ电极成功除颤能量分别为15、25、25和15J。使用常规ICD和CRT-D时CAN→右心室(RV),SubQ的相应除颤阈值分别为6、10、15和10J。结论SubQ电极植入不但安全而且有效。SubQ电极的应用可望避免植入过程中心血管并发症和胸腔并发症的发生,减少甚至避免放射线,对于幼年儿童和血管病变无法植入电极导线者可望有更为重要的价值。
Purpose To address the difficulties of using implantable cardioverter-defibrillators (ICDs) in patients with subclavian vein occlusion and young children, this study was designed to evaluate the feasibility of sub-wound defibrillation (SubQ) electrodes and their defibrillation effects . Methods A total of 4 patients were included in the study. Age 63,64,85,48 years old. Among them, 3 cases of male patients with underlying heart disease as coronary heart disease, 1 female (48 years) as dilated cardiomyopathy. Patients with a history of ventricular tachycardia (VT), ventricular fibrillation (VF) or electrophysiological examination induced sustained ventricular tachycardia. The SubQ electrode was delivered remotely to the spine through a 2 cm longitudinal incision in the 6th intercostal space of the left axillary midline, and another subcutaneous tunnel in the forward anterior direction of the proximal electrode of the SubQ reached the pocket of the ICD under the left subclavian. Simulated active defibrillator housing (CAN) via the left subclavian ICD Placement of the capsular bag incision in the tunnel between the pectoralis major and the chest wall down to the left near the lower end of the sternum. The defibrillation test energies between CAN and SubQ electrodes were 35, 25 and 15 J, respectively. After the test, 3 patients were implanted ICD according to the conventional method. Another patient was implanted with a three-chamber defibrillator (CRT-D) because left ventricular ejection fraction was below 0.35. SubQ electrodes were reserved for all patients and their defibrillation thresholds were tested before the procedure ended. The energy used is 3,6,10,12,15 and 18J. Results All patients had successful implantation without complications. Four patients had X-ray exposure times of 37, 20, 9 and 52 min, respectively. The successful defibrillation energies of CAN → SubQ electrodes were 15, 25, 25 and 15J, respectively. The corresponding defibrillation threshold for SubQ with CAN → right ventricle (RV) at conventional ICD and CRT-D was 6, 10, 15 and 10 J, respectively. Conclusion SubQ electrode implantation is not only safe and effective. The use of SubQ electrodes is expected to prevent cardiovascular complications and chest complications during implantation, reduce or even avoid radiation, and may be of even greater value to young children and the inability to implant electrode leads in vascular lesions.