Kleinert M, Beer P, Nahrstedt J
J Thorac Cardiovasc Surg. 1976 Apr;71(4):493-501.
The clinical utilization of atrial programmed pacemakers is limited by the lead systems available for sensing of atrial activity. The endocardial method of lead placement is burdened by a dislodgement rate of up to 30 per cent. Alternatively, the patient must submit to the risks of a thoracotomy. Thirty-one patients have been treated with a transmediastinally, retrocardially positioned atrial detector electrode. In 20 patients (65 per cent) the detector performed as desired with no postimplant revision. In 11 patients (35 per cent) corrective measures were required primarily to correct lead placement; seven of these were corrected under local anesthesia merely by pulling the catheter. Spontaneous lead dislocation occurred in four patients. Four patients (13 per cent) underwent remediastinoscopy due to cranial displacement of the detector electrode with a resulting decrease in atrial potential to less than 0.5 mV. For technical reasons, the lead placements were performed without the benefit of x-ray illumination, with only an ECG check of the posterior atrial wall, and this may account for the relatively high incidence of revision. Transmediastinal placement of sensing electrodes presents a practicable alternative to methods presently used.
心房程控起搏器的临床应用受到可用于感知心房活动的导联系统的限制。心内膜导联置入方法的电极脱位率高达30%。另外，患者必须承受开胸手术的风险。31例患者接受了经纵隔、心后位心房探测电极治疗。20例患者（65%）探测器按预期运行，植入后无需修正。11例患者（35%）主要需要采取纠正措施来校正导联位置；其中7例仅在局部麻醉下通过牵拉导管得以纠正。4例患者发生自发性导联脱位。4例患者（13%）因探测电极向头侧移位导致心房电位降至0.5 mV以下而接受了纵隔镜检查。由于技术原因，导联置入是在没有X线透视的情况下进行的，仅通过心电图检查心房后壁，这可能是修正发生率相对较高的原因。纵隔内传感电极置入是目前所用方法的一种可行替代方案。
