微创医学

目的对比分析左室四极电极与左室双极电极在扩张型心肌病患者心脏再同步化治疗（CRT）中的安全性和有效性。方法纳入24例扩张型心肌病患者，将其随机分为对照组及观察组，每组12例，均行CRT，其中对照组用左室双极电极，观察组用左室四极电极。比较两组手术时间、术中靶静脉选择情况，术后1个月内电极脱位、膈神经刺激和阈值升高发生率，以及术后6、18、30个月6分钟步行试验、左室射血分数（LVEF）、左室舒张末期内径（LVEDD）、血清B型钠尿肽前体（NT-proBNP）水平，统计随访期间两组全因死亡率等指标。结果两组靶静脉选择、手术时间差异均无统计学意义（均P＞0.05）。两组QRS时限、6分钟步行试验、LVEF、LVEDD、NT-proBNP比较，差异均有统计学意义（均P＜0.05）；除LVEDD外，两组上述指标均随时间明显增加或降低（均P＜0.05），且时间与分组间无交互作用（均P＞0.05）。随访 30个月，对照组死亡4例（33.3%），观察组死亡1例（8.3%）。两组死亡率比较，差异无统计学意义（P＞0.05）。对照组电极脱位2例（16.7%）、膈神经刺激4例（33.3%）、阈值升高1例（8.3%）。观察组发生膈神经刺激1例（8.3%）、阈值升高1例（8.3%）。两组并发症发生率比较（58.3% vs. 16.7%），差异无统计学意义（P＞0.05）。结论扩张型心肌病CRT中应用左室四极电极不仅能有效减少电极脱位、膈神经刺激的发生，还可以有效改善中远期预后。

ObjectiveTo compare the safety and effectiveness between left ventricular quadripolar and left ventricular bipolar lead for cardiac resynchronization therapy (CRT) in patients with dilated cardiomyopathy. MethodsA total of 24 patients with dilated cardiomyopathy were enrolled and randomly divided into control group and observation group, with 12 cases in each group. CRT was performed in all patients, of which left ventricular bipolar was used in the control group and left ventricular quadripolar was used in the observation group. The operation time, intraoperative target vein selection, the incidence of electrode dislocation, phrenic nerve stimulation and threshold elevation within 1 month after surgery, the 6-minute walk test, left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDD), serum N-Terminal pro-B-Type natriuretic peptide (NT-proBNP) levels at 6, 18 and 30 months after surgery were compared between the two groups. The all-cause mortality rate and other indicators of the two groups were counted during the follow-up period. ResultsThere were no statistically significant differences in target vein selection and operation time between the two groups (all P＞0.05). There were statistically significant differences in QRS duration, 6-minute walk test, LVEF, LVEDD and NT-proBNP between the two groups (all P＜0.05). Except for the LVEDD, the indicators mentioned above in both groups increased or decreased over time (all P＜0.05), and there was no interaction between time and groups (all P＞0.05). After 30 months of follow-up, 4 patients (33.3%) died in the control group and 1 patient (8.3%) in the observation group, there was no statistically significant difference in mortality between the two groups (P＞0.05). In the control group, 2 cases (16.7%) occurred electrode dislocation, 4 cases (33.3%) occurred phrenic nerve stimulation and 1 case (8.3%) with the elevated threshold. Phrenic nerve stimulation was found in 1 case (8.3%) and the threshold increased in 1 case (8.3%) in the observation group. There was no statistically significant difference in the incidence of complications between the two groups (58.3% vs. 16.7%, P＞0.05). ConclusionThe application of left ventricular quadripolar lead for CRT in dilated cardiomyopathy can not only effectively reduce the occurrence of electrode dislocation, phrenic nerve stimulation, but also effectively improve the long-term prognosis.