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首页> 外文期刊>PACE: Pacing and clinical electrophysiology >Permanent pacing in Ebstein's anomaly.
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Permanent pacing in Ebstein's anomaly.

机译：永久调整Ebstein异常。

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Patients with Ebstein's anomaly present unique challenges to permanent pacing due to anatomical variations and tricuspid valve replacement. We retrospectively reviewed our experience with permanent pacing in patients with Ebstein's anomaly between 1976 and 1993. We identified 401 patients with Ebstein's anomaly, of whom 15 (3.7%) required permanent pacing (1 of the 15 was implanted elsewhere). Of the 15, there were 8 females and 7 males (mean age 32 years [range 7-74]); the indications for pacing were AV block in 11 and sinus node dysfunction in 4. Eight patients were programmed with VVI and seven with DDD. All VVI patients were paced epicardially. Two patients with DDD pacemakers had transvenous atrial and ventricular leads, 4 DDD patients had transvenous atrial leads and epicardial ventricular leads, and 1 patient had both epicardial and transvenous systems. Associated surgical procedures included tricuspid valve replacement in 14 of 15, atrial septal defect repair in 10 of 15, atrioplasty in 7 of 15, prior tricuspid annuloplasty in 4 of 15, pulmonary vein dilation in 1 of 15, and conduction system ablation in 2 of 15. Patients had a mean follow-up of 35 months (range 1-168 months). Complications requiring operative intervention occurred in four patients. One patient had displacement of a transvenous ventricular lead. A second patient had an epicardial lead failure. A third patient had a nonfunctioning atrial lead that displaced across the tricuspid valve, causing severe tricuspid regurgitation. The fourth patient had multiple epicardial and endocardial leads exit block with secondary diaphragmatic stimulation. Permanent pacemakers were required in 3.7% of patients with Ebstein's anomaly, with the indication being intrinsic conduction disease in the majority of patients. Ninety-three percent of patients required tricuspid valve replacement, suggesting more severe manifestation of Ebstein's anomaly. Twenty-seven percent had complications requiring surgical intervention. Thus, permanent pacing in patients with Ebstein's anomaly can be challenging and should be approached by an experienced physician.
机译：由于解剖学变化和三尖瓣置换术，患有Ebstein异常的患者对永久起搏提出了独特的挑战。我们回顾性地回顾了我们在1976年至1993年之间对Ebstein异常患者进行永久起搏的经验。我们确定了401例Ebstein异常患者，其中15例（3.7％）需要永久起搏（15例中的1例植入其他地方）。在这15位中，有8位女性和7位男性（平均年龄32岁[范围7-74]）;起搏的指征是11例有AV阻滞，4例有窦房结功能障碍。8例患者接受VVI编程，7例接受DDD编程。所有VVI患者均心外膜起搏。 2例DDD心脏起搏器患者有经心房和心室导联，4例DDD患者有静脉心房和心外膜心室导联，1例同时有心外膜和静脉系统。相关的外科手术包括在15中的14中更换三尖瓣，在15中的10中进行房间隔缺损修复，在15中的7中进行房室成形术，在15中的4中进行三尖瓣瓣环成形术，在15中的1中进行肺静脉扩张，在2中的2中进行传导系统消融。 15.患者平均随访35个月（范围1-168个月）。需要手术干预的并发症发生在四名患者中。 1例患者经静脉室导联移位。第二例患者发生心外膜导联失败。第三名患者的心房导线功能异常，横穿三尖瓣移位，导致严重的三尖瓣关闭不全。第四例患者有多个心外膜和心内膜导联出口阻滞，继发diaphragm肌刺激。 Ebstein异常患者中有3.7％需要永久性起搏器，这表明大多数患者患有内在传导疾病。百分之九十三的患者需要三尖瓣置换术，提示埃伯斯坦异常表现更为严重。 27％的并发症需要手术干预。因此，对于具有Ebstein异常的患者进行永久起搏可能具有挑战性，应由经验丰富的医生进行咨询。

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