CAJ | 학술논문

目的：评估左心室四极导线在心脏再同步治疗中的临床应用。方法选择符合心脏再同步治疗（CRT）适应证患者30例，分为左心室四极导线组和双极导线组。比较两组在临床疗效、同步性、手术时间及并发症等方面的差异。结果两组患者左室导线置入时间、手术时间、X 线曝光时间、左室导线位置均无显著差异。四极导线组可选择的起搏向量远多于双极导线组。术后1个月的超声优化程控显示，四极导线组优化后主动脉射血速度时间积分（AOVTI）和左室同步性均显著改善，同时优于双极导线组优化后（P ＜0．05）。随访至术后6个月，四极导线组的左室射血分数优于双极导线组（P ＜0．05）。结论左心室四极导线与双极导线具有同样的安全性，其血液动力学、同步性和短期临床疗效优于双极导线，并可能有助于减少膈神经刺激避免二次手术等并发症。
목적：평고좌심실사겁도선재심장재동보치료중적림상응용。방법선택부합심장재동보치료（CRT）괄응증환자30례，분위좌심실사겁도선조화쌍겁도선조。비교량조재림상료효、동보성、수술시간급병발증등방면적차이。결과량조환자좌실도선치입시간、수술시간、X 선폭광시간、좌실도선위치균무현저차이。사겁도선조가선택적기박향량원다우쌍겁도선조。술후1개월적초성우화정공현시，사겁도선조우화후주동맥사혈속도시간적분（AOVTI）화좌실동보성균현저개선，동시우우쌍겁도선조우화후（P ＜0．05）。수방지술후6개월，사겁도선조적좌실사혈분수우우쌍겁도선조（P ＜0．05）。결론좌심실사겁도선여쌍겁도선구유동양적안전성，기혈액동역학、동보성화단기림상료효우우쌍겁도선，병가능유조우감소격신경자격피면이차수술등병발증。
Objective To evaluate the application of quadripolar left ventricular lead in cardiac resynchronization therapy (CRT).Methods Patients who met the indications for CRT were enrolled in this study,and received car-diac resynchronization therapy defibrillator (CRT-D)device with quadripolar (quadripolar lead group)or bipolar (Bipolar lead group)left ventricular Lead.The short term clinical effect,synchronization,operation time and com-plications were then evaluated.Results There were no significant differences in coronary sinus calculation to final LV lead placement,operation time,fluoroscopy time and the location of LV lead between the two groups.Quadpi-polar lead group had significant and more usable configurations than bipolar lead group.Echo optimization showed that the aortic velocity time integral (AOVTI)and LV synchronization were significantly improved in quadripolar lead group one month after implantation.AOVTI (19.7 ±0.8 vs 18.9 ±1.1,P <0.05)and LV synchronization (78.9 ±16.0 vs 90.3 ±12.0 ms,P <0.05)were better in Quadripolar lead group than in bipolar lead group. There were significant differences in left ventricular ejection fraction between the two groups six month after implan-tation (37.1 ±5.1% vs 32.9 ±5.5%,P <0.05).Conclusion The safety of quadripolar LV lead is the same as bipolar one.Quadripolar LV lead 's hemodynamics,LV synchronization and short term clinical effect are signifi-cantly better than Bipolar LV lead,and may help to reduce phrenic nerve stimulation.