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首页> 外文期刊>PACE: Pacing and clinical electrophysiology >Right ventricular outflow tract pacing: practical and beneficial. A 9-year experience of 460 consecutive implants.
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Right ventricular outflow tract pacing: practical and beneficial. A 9-year experience of 460 consecutive implants.

机译：右室流出道起搏：实用且有益。连续460次植入的9年经验。

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BACKGROUND: Pacing from the right ventricular apex (RVA) in patients with ventricular dysfunction has been identified as a possible contributor to deterioration of ventricular function. Therefore, alternative pacing sites such as the right ventricular outflow tract (RVOT) are receiving intensified scrutiny. An unresolved question is whether technical, procedural, and stability issues are comparable for the RVA and the RVOT. METHODS: This report details 460 consecutive ventricular pacing lead implants with the primary intended site in the RVOT. Patients were evaluated for success, complication rates, and followed-up for stability of pacing parameters. The total patient implant population included 300 male and 170 female patients with a mean age of 70.6 years. Ten patients were excluded from the analysis, since there was a primary indication and intention to implant in the RVA, leaving a total of 460 patients for analysis. The indications for pacing were symptomatic bradycardia due to any cause and/or Mobitz II or complete heart block. There was no clinical evidence of heart failure in 420 patients. In 40 patients with heart failure, the indication for pacing was cardiac resynchronization therapy using the RVOT as an alternate site when pacing from a branch vein of the coronary sinus was not possible. Outcome information was obtained from the implanter's clinic. RESULTS: The overall success rate in the RVOT was 84% over the total 9-year period with a 92% success rate in the last 4(1/2) years, using the RVOT technique described. At 20 months in a subgroup comparison of RVOT and RVA implants, there was no significant difference in pacing threshold, R-wave sensing, or pacing lead impedance. Dislodgment occurred in only 1 of 460 patients. Reasons for failure to implant in the RVOT include inability to find a stable position with adequate pacing and sensing thresholds (related to anatomy, scarred myocardium, pulmonary hypertension, tricuspid regurgitation), hemodynamic instability limiting time for implant, anda learning curve. Long-term stability and lead performance were excellent, and certain acute and chronic complications of RV pacing did not occur.
机译：背景：在心室功能不全的患者中，从右心尖（RVA）起搏已被确定为导致心室功能恶化的可能原因。因此，其他起搏部位，如右心室流出道（RVOT），正在受到严格的检查。一个尚未解决的问题是RVA和RVOT的技术，程序和稳定性问题是否具有可比性。方法：本报告详细介绍了460例连续的心室起搏导线植入物，其主要目标部位位于RVOT中。对患者的成功率，并发症发生率和起搏参数稳定性进行随访。患者植入物总数包括300名男性和170名女性患者，平均年龄为70.6岁。由于有主要指征并打算将其植入RVA中，因此将10名患者排除在分析之外，总共有460名患者需要分析。起搏的适应症是由于任何原因引起的症状性心动过缓和/或Mobitz II或完全性心脏传导阻滞。没有420名患者的心力衰竭临床证据。在40例心力衰竭患者中，起搏的指征是当无法从冠状窦的分支静脉起搏时，以RVOT作为替代部位进行心脏再同步治疗。结果信息从种植者的诊所获得。结果：使用所述的RVOT技术，在整个9年的时间里，RVOT的总体成功率为84％，最近4（1/2）年的成功率为92％。在RVOT和RVA植入物的亚组比较中，在20个月时，起搏阈值，R波感应或起搏导线阻抗无显着差异。 460例患者中只有1例发生移位。无法在RVOT中植入的原因包括无法找到足够的起搏和感应阈值（与解剖结构，心肌疤痕，肺动脉高压，三尖瓣关闭不全相关）的稳定位置，血液动力学不稳定限制了植入时间以及学习曲线。长期稳定性和铅性能极好，并且未发生RV起搏的某些急性和慢性并发症。

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