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Title:: Comparison of coronary sinus catheterization via femoral or subclavian vein approach

作者:: 曾国良¹; 孟素荣²; 何利伟²; 彭健²; (1.肇庆市第一人民医院心内科，广东肇庆 526000；
2.南方医科大学南方医院心血管内科，广东广州 510515)

Author(s):: ZENG Guo-liang¹; MENG Su-rong²; HE Li-wei²; PENG Jian²; (1.Department of Cardiology, Zhaoqing First People’s Hospital, Zhaoqing 526000, Guangdong, China；
2.Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guandong, China)

关键词:: 股静脉; 锁骨下静脉; 可调弯电极; 固定弯电极

Keywords:: femoral vein; subclavian vein; steerable catheter; fixed curve catheter

分类号:: R543.3；R331.38

DOI:: -

文献标识码:: A

摘要:: 目的:比较经锁骨下静脉及股静脉途径放置冠状窦电极的有效性及安全性。方法:连续纳入2010年1月~2012年5月行电生理检查及射频消融641例患者，分为2组：锁骨下静脉组（321例）穿刺锁骨下静脉放置固定弯十极冠状窦电极；股静脉组（320例）穿刺股静脉放置可调弯十极冠状窦电极。比较两组成功率及并发症发生率。结果:锁骨下静脉组中穿刺成功317例（穿刺成功率98.8%），其中3例术后检查出现气胸,1例因误置入6F鞘管到锁骨下动脉停止手术，气胸患者中1例因面积>30%行闭式引流,另2 例未行特殊处理自行吸收,4例患者均未留下后遗症，该组并发症发生率为1.2%。该组置入鞘管的320例患者中307例成功放置固定弯冠状窦电极，置入电极成功率为95.9%。13例（4.1%）不成功者改经股静脉途径12例成功置入电极。股静脉组333例（锁骨下静脉组电极置入不成功者也改用股静脉途径，该组实际人数：320+13=333）均穿刺成功,其穿刺成功率为100%，3例未能成功置入冠状静脉电极，置入电极成功率为99.1%。此3例未能置入患者行逆行冠状静脉造影后经股静脉成功置入电极。股静脉组电极置入成功率显著高于锁骨下静脉组（99.1% vs. 95.9%，P<0.01）。锁骨下静脉组并发症稍多于股静脉组，但差异无统计学意义。两组穿刺成功率和曝光时间［(77±40)s vs.(75±46)s］，无显著差异。股静脉组总成功率显著高于锁骨下静脉组［99.1% vs. 94.7%,P<0.01］。结论:两种途径放置冠状窦电极成功率均较高，并发症发生率较低，股静脉组总成功率显著高于锁骨下静脉组。

Abstract:: AIM:To compare the effectiveness and safety of coronary sinus catheterization via femoral or subclavian vein approach. METHODS: Six hundred and forty-one consecutive patients undergoing electrophysiological study or radiofrequency catheter ablation admitted to our department from January 2010 to May 2012 were prospectively assigned in a random fashion to either the femoral vein access (FVA) with a steerable curve deca-polar catheter (n=321) or the subclavian vein access (SVA) with a fixed curve deca-polar catheter (n=320). If one approach is unsuccessful, the other approach was tried. The success rate, complication rate and exposure time was compared. RESULTS: In the SVA group, puncture was successful in 317 cases (puncture success rate was 98.8%). Among the four failed cases, three were diagnosed with pneumothorax after postoperative examination, and the other procedure was cancelled due to mispuncture of the subclavian artery and a 6F sheath was inserted. One of the three pneumothorax patients needed closed thoracic drainage, and the other two absorbed automatically without medical intervention. None of the patients had any sequelae. In the SVA group, complication rate was 1.2%; 307/320 were successful in placing coronary sinus electrode, success rate of catheteration was 95.9%, 12 of the failed 13 cases (4.1%) were successfully catheterized via femoral vein approach. All 333 cases (the 13 failed patients were alternated to this group; thus, the number of this group was 333) were successfully punctured in the FVA group, the punture success rate was 100%, three cases failed in coronary sinus catheterization, success rate of catheteration was 99.1%. The three failed cases were successfully catheterized via femoral venous pathways after retrograde coronary vein angiography. The success rate of electrode placement was significantly higher in the FVA group than in the SVA group (99.1 vs. 95.9%, P<0.01). The rate of severe complications was slightly higher in the SVA group than in the FVA group without significant difference. The success rate of puncture, exposure time ［(77±40) s vs.(75±46) s, P>0.05］ was similar between groups. Overall success rate of the FMV group was significantly higher than the SVC group (99.1 vs. 94.7%, P<0.01). CONCLUSION: Both approaches have a high success rate in coronary sinus electrode placement and a low incidence of complications. Overall success rate of the FMV group is significantly higher than the SVC group.

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经锁骨下静脉及股静脉途径置入冠状窦电极的比较

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

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