CRT植入方法进展

1、1会计学CRT植入方法进展植入方法进展21.A step-by-step approach. Westborough: Blackwell Futura; 2004.2. Rev Cardiovasc Med. 2003;4:142-9.3.Pacing Clin Electrophysiol. 2004;27:783-90.4. Am J Cardiol. 2000;86:157K-64K.5. Heart. 2001;86:40510.6.J Am Coll Cardiol. 2005;46:2348-56.7. AmJ Cardiol 2000; 86:K157K164.8. Eur H

2、eart J 2001; 23:682686.牛牛文库文档分享3牛牛文库文档分享4牛牛文库文档分享心脏后静脉心脏后静脉后静脉与心后静脉与心中交通支中交通支双导丝技术双导丝技术5PTCAPTCA导丝的应用技术导丝的应用技术牛牛文库文档分享造影导管造影导管导引钢丝导引钢丝PTCAPTCA导丝导丝左室导线左室导线6牛牛文库文档分享7牛牛文库文档分享8牛牛文库文档分享 对较大右心房可对较大右心房可 提供额外的支撑提供额外的支撑CS CS 开口在高位右房开口在高位右房有冠状窦瓣的有冠状窦瓣的CSCS较大右心房较大右心房 且且CSCS垂直开口垂直开口巨大心脏巨大心脏6218A-AM(Amplasz) 62

3、18A-EH(Extended Hook) 6218A- 57S(Straight)6216A-MP(Multipurpose) 递送系统递送系统Attain Attain 特殊规格递送系统特殊规格递送系统Attain Attain 分支静脉递送系统分支静脉递送系统Attain Command Attain Command 左室递送系统左室递送系统牛牛文库文档分享90o180oStraight牛牛文库文档分享 CPS DirectCPS Direct SL SL切开型外鞘有切开型外鞘有7 7种种不同弯度不同弯度 3 3种型号适合从下方寻找种型号适合从下方寻找CSCS 2 2种型号适合从上方寻找

4、种型号适合从上方寻找CSCS 2 2种型号适合右侧植入种型号适合右侧植入 直鞘适合与可控导管直鞘适合与可控导管( (如如: CPS : CPS LuminaryLuminary 双弯导管双弯导管) )一起使用一起使用 与其他公司产品相比，与其他公司产品相比，SJM SJM 提供提供了更多角度的选择了更多角度的选择超宽超宽宽宽135115多用途多用途右侧右侧直型直型适合任何解剖结构适合任何解剖结构7 7 种弯度种弯度11牛牛文库文档分享90 Standard90 Flex90 SupportObtuseAcuteQuartet IS4 LV Lead左室导线的改进：左室导线的改进：易操作，稳定性

5、好易操作，稳定性好；脱位率低；脱位率低；隔神经剌激更低。隔神经剌激更低。牛牛文库文档分享固位袖套临时固位夹蓝色推送管三组伞叶三组伞叶不透光指示不透光指示环环完全伸展伞叶为完全伸展伞叶为 6.6-8.0 mm (22-24 Fr)牛牛文库文档分享 441441患者，平均随访患者，平均随访2323个月个月 （其中（其中408408位患者尝试植入）位患者尝试植入） 植入成功率：植入成功率：94%94%（385385例植入成功）例植入成功） 96.3% “96.3% “非前壁非前壁” ” 部位，阈值和感知在随访期间保持稳定部位，阈值和感知在随访期间保持稳定 脱位率：脱位率：0.7%0.7% 膈神经刺激

6、：膈神经刺激： 2.5%2.5%牛牛文库文档分享多种起搏矢量的灵活选择解决多种起搏矢量的灵活选择解决膈神经刺激膈神经刺激，优化阈值，避免创伤性的电极导线重置优化阈值，避免创伤性的电极导线重置牛牛文库文档分享VectorDescriptionCathodeAnodeVector 1Distal Tip to Mid 2D1M2Vector 2Distal Tip to Proximal 4D1P4Vector 3Distal Tip to RV coilD1RV CoilVector 4Mid 2 to Proximal 4M2P4Vector 5Mid 2 to RV coilM2RV Coi

7、lVector 6Mid 3 to Mid 2M3M2Vector 7Mid 3 to Proximal 4M3P4Vector 8Mid 3 to RV CoilM3RV CoilVector 9Proximal 4 to Mid 2P4M2Vector 10Proximal 4 to RV CoilP4RV Coil牛牛文库文档分享18牛牛文库文档分享19Goal is to place lead posterior to obtuse marginal artery nearest LA appendageGoal is to place lead posterior to obtuse

8、 marginal artery nearest LA appendage牛牛文库文档分享20心脏侧静脉心脏侧静脉心外膜起搏导线心外膜起搏导线已缝合已缝合牛牛文库文档分享21胸腔引流管胸腔引流管分别缝分别缝合切口合切口第四肋第四肋间切口间切口起搏器起搏器囊袋囊袋心内、心外科合作心内、心外科合作牛牛文库文档分享22牛牛文库文档分享23PACE 1998; 2lPt. 11:2128-2131Case Report:A 73-year-old man with severe ischemic cardiomyopathy (two previous myocardial infarction an

9、d two coronary artery bypass grafting surgeries)presented with refractory CHF牛牛文库文档分享24The patient is presently doing well after 15 months on antifailure and anticoagulant treatment. He has had no evidence or symptoms suggestive of any embolic episode.PACE 1998; 2lPt. 11:2128-2131牛牛文库文档分享25Heart Rhy

10、thm, Vol 4, No 4, April 2007牛牛文库文档分享26N=10. In two of the first four patients, dislodgement of the lead was observed within 24 hours after implantation. In one patient, the lead could be repositioned by insertion of a stylet; in the second patient, reinsertion of the deflectable catheter was necessa

11、ry. Insufficient slack in the lead was considered as the main cause of the dislodgements. There was no phrenic nerve stimulation observed in any of the patients. There were no thromboembolic complications at follow-up.Heart Rhythm, Vol 4, No 4, April 2007牛牛文库文档分享27J Interv Card Electrophysiol牛牛文库文档分

12、享28J Interv Card Electrophysiol牛牛文库文档分享29Neth Heart JDOI 10.1007/s12471-011-0210-5牛牛文库文档分享30Neth Heart JDOI 10.1007/s12471-011-0210-5牛牛文库文档分享31牛牛文库文档分享32Kassai I, Foldesi C, Szekely A, et al. Alternative method for cardiac resynchronization: transapical lead implantation. Ann Thorac Surg. 2009;87:65

13、02.牛牛文库文档分享Circ Arrhythm Electrophysiol 2009;2:580 7.牛牛文库文档分享Circ Arrhythm Electrophysiol 2009;2:580 7.牛牛文库文档分享JACC Vol. 55, No. 6, 2010, 566-575牛牛文库文档分享JACC Vol. 55, No. 6, 2010, 566-575牛牛文库文档分享37J Am Coll Cardiol 2010;56:74753牛牛文库文档分享38Transseptal Passage of a Left Ventricular Endocardial LeadThro

14、mboembolic complications. Gelder et al. (21) found that the diagnosis of lead misplacement was made after thromboembolic complications inapproximately one-third of cases.Interaction with the mitral valve.The interference of the lead with the valve, including increased risk of insufficiency and endoc

15、arditis in case of infectious complications, may be a major concern.Risks associated with extraction of the cardiac resynchronization system. Because of the risk of systemic embolizationof vegetations, thrombi, or fibrous material surrounding the lead, percutaneous procedures seem excessively risky.

16、J Am Coll Cardiol 2010;56:74753需终生抗凝！安全性？可靠性？需终生抗凝！安全性？可靠性？等等，尚需循证医学证据等等，尚需循证医学证据! !牛牛文库文档分享牛牛文库文档分享40牛牛文库文档分享41牛牛文库文档分享42牛牛文库文档分享431.A step-by-step approach. Westborough: Blackwell Futura; 2004.2. Rev Cardiovasc Med. 2003;4:142-9.3.Pacing Clin Electrophysiol. 2004;27:783-90.4. Am J Cardiol. 2000;86

17、:157K-64K.5. Heart. 2001;86:40510.6.J Am Coll Cardiol. 2005;46:2348-56.7. AmJ Cardiol 2000; 86:K157K164.8. Eur Heart J 2001; 23:682686.牛牛文库文档分享44牛牛文库文档分享心脏后静脉心脏后静脉后静脉与心后静脉与心中交通支中交通支双导丝技术双导丝技术45PTCAPTCA导丝的应用技术导丝的应用技术牛牛文库文档分享 对较大右心房可对较大右心房可 提供额外的支撑提供额外的支撑CS CS 开口在高位右房开口在高位右房有冠状窦瓣的有冠状窦瓣的CSCS较大右心房较大右心房 且且CSCS垂直开口垂直开口巨大心脏巨大心脏6218A-AM(Amplasz) 6218A-EH(Extended Hook) 6218A- 57S(Straight)6216A-MP(Multipurpose) 递送系统递送系统Attain