CRT植入方法进展沈法荣教授.ppt

* 植入方法进展 经胸左室心外膜起搏： 开胸植入或经胸腔镜植入 （mini-thoracotomy, video-assisted thoracoscopic surgery (VATS) and robotic surgery） 穿间隔左室心内膜起搏 经皮穿心包植入心外膜导线 * 心外膜起搏导线的植入 Goal is to place lead posterior to obtuse marginal artery nearest LA appendage * 心外膜起搏导线的植入 心脏侧静脉 心外膜起搏导线已缝合 * 胸腔引流管 分别缝合切口 第四肋间切口 起搏器囊袋 心内、心外科合作 * 植入方法进展 经胸左室心外膜起搏： 开胸植入或经胸腔镜植入 （mini-thoracotomy, video-assisted thoracoscopic surgery (VATS) and robotic surgery） 穿间隔左室心内膜起搏 经皮穿心包植入心外膜导线 Endocardial Biventricular Pacing--First method * PACE 1998; 2l[Pt. 11:2128-2131 Case Report: A 73-year-old man with severe ischemic cardiomyopathy (two previous myocardial infarction and two coronary artery bypass grafting surgeries) presented with refractory CHF Endocardial Biventricular Pacing * The 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; 2l[Pt. 11:2128-2131 * Heart Rhythm, Vol 4, No 4, April 2007 Endocardial Biventricular Pacing--Second method Endocardial Biventricular Pacing--Second method * N=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 necessary. 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 * J Interv Card Electrophysiol Endocardial Biventricular Pacing--Third method Endocardial Biventricular Pacing--Third method * J Interv Card Electrophysiol Superior RF septum perforation and lead introduction * Neth Heart J DOI 10.1007/s12471-011-0210-5 Femoral lead introduction with lead retrieval to the pocket Transfemoral introduction of the lead with a subcutaneous and an endovascular route.