永久性起搏器导线误植入左心室的临床表现、处理及预后

Clinical features, management and prognosis of permanent ventricular pacing lead malpositioned in left ventricle

摘要:

目的  总结有关永久性起搏器导线误植入左心室的临床表现、处理及预后，促进临床对该并发症的了解，为选择左室心内膜起搏心脏再同步化治疗提供临床经验。方法  通过Pubmed、OVID、EMBASE、EBSCO、Science Direct、CNKI、VIP和万方数据库等检索有关永久性起搏器导线误植入左心室的英文和中文文献报道。结果  共有72篇文献，85例患者。男、女各占49.4%。导线主要通过经房间隔途径（78.8%）和主动脉逆行途径（18.8%）进入左室。起搏心电图、正侧位胸片、经胸或食道心脏超声等表现异常，起搏心电图表现为类右束支组织样图形，心脏超声可见导线进入左室。26例（30.6%）患者出现脑栓塞事件，最短为术后2 d。39例（45.9%）患者病程中未使用抗栓药物但没有发生栓塞事件。华法林和阿司匹林均可预防栓塞事件，但阿司匹林疗效不如华法林。8.2%的患者出现二尖瓣装置的损害如瓣膜穿孔、二尖瓣返流；7%的患者发生起搏装置感染。治疗可采取终生抗凝、经皮拔除导线和开胸切除导线等方式，充分抗凝治疗可有效预防栓塞事件发生。结论  永久性起搏器导线误植入左心室栓塞事件发生率较高，充分抗凝治疗可预防栓塞事件的发生。

Abstract:

Objective To assess the clinical features, management and prognosis of permanent ventricular pacing leads unintentionally malpositioned in the left ventricle. Methods Relevant literature was collected by searching the databases including PubMed, OVID, Embase, EBSCO, ScienceDirect, CNKI, VIP and Wanfang. Results Till July 2015, 85 cases from 72 papers were enrolled in. Pacing leads were mostly malpositioned into left ventricle via atrial septum (78.8%) and aorta (18.8%). Electrocardiogram, chest X-ray, especially the lateral view, CT and echocardiography showed the unusual position of pacing leads. The rates of thromboembolic events, mitral valve damage and the infection of pacemaker were 30.6%, 8.2% and 7% respectively. Thromboembolic events could be successfully prevented by life-long anticoagulant such as Warfarin or pacing lead extraction without complication or sequelae. Conclusions Pacing leads malpositioned in left ventricle may lead to thromboembolic events, which can be prevented by anticoagulant.