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目的 :观察慢性心力衰竭患者腋静脉的解剖特征,并探讨心脏再同步化治疗(CRT/CRTD)中经腋静脉途径植入左室导线的可行性和安全性。方法:选择2013年1月—2015年2月行心脏再同步化治疗(CRT或CRTD)患者59例,根据左室导线植入径路分为腋静脉组(n=23)和锁骨下静脉组(n=36),比较两种径路左室导线植入时间、参数及相关并发症;同期选择新植入双腔起搏器(DDD)患者67例,所有患者术前行腋静脉造影,比较慢性心力衰竭和正常心脏结构患者腋静脉内径的差异。结果:所有患者均成功植入CRT/CRTD和DDD装置。心脏再同步化治疗组和双腔起搏器组腋静脉解剖结构相似,两组间腋静脉内径无统计学差异[(10.77±2.19)mm vs(10.11±2.02)mm,P>0.05];心脏再同步化治疗经腋静脉径路和经锁骨下静脉径路植入左室导线的时间、植入并发症无统计学差异(P>0.05);右房、右室、左室导线的阈值、感知、阻抗两组间无统计学差异(P>0.05)。结论 :慢性心力衰竭患者腋静脉内径无明显异常,心脏再同步化治疗中经腋静脉径路植入左室导线安全可行。
Objective: To observe the anatomical characteristics of axillary vein in patients with chronic heart failure and to investigate the feasibility and safety of transposition of left ventricular lead via axillary vein in cardiac resynchronization therapy (CRT / CRTD). Methods: Fifty-nine patients underwent cardiac resynchronization therapy (CRT or CRTD) from January 2013 to February 2015 were divided into axillary vein group (n = 23) and subclavian vein group n = 36). The time, parameters and related complications of left ventricular lead were compared between the two approaches. In the same period, 67 patients with newly implanted double chamber pacemaker (DDD) were selected. All patients underwent axillary venography before operation, Differences in axillary diameter of patients with heart failure and normal heart structure. Results: All patients were successfully implanted with CRT / CRTD and DDD devices. The cardiac resynchronization therapy group and the double-chamber pacemaker group axillary vein anatomical structure similar to the two groups of axillary vein diameter was no significant difference [(10.77 ± 2.19) mm vs (10.11 ± 2.02) mm, P> 0.05]; heart Resynchronization therapy of axillary vein approach and subclavian vein approach left ventricular lead implantation time, no significant difference in implantation complications (P> 0.05); right atrium, right ventricle, left ventricular lead threshold, perception, Impedance no significant difference between the two groups (P> 0.05). Conclusions: The diameter of axillary vein in patients with chronic heart failure has no obvious abnormality. It is safe and feasible to implant the left ventricular lead via the axillary vein during cardiac resynchronization therapy.