Driever R, Horlitz M, Müller M, Fuchs S, Gülker H, Vetter H
Klinik für Herz- und Thoraxchirurgie, Herzzentrum, Universität Witten/Herdecke, Wuppertal.
Zentralbl Chir. 2003 Apr;128(4):273-7. doi: 10.1055/s-2003-38789.
Evaluating the efficiency of a prescribed concept for atrial lead placement in cases of intraoperative atrial fibrillation (AF).
Over the period from 11/1998 to 5/2000, we carried out a prospective study on 40 patients with AF. After implantation of the screw electrode into the lateral wall of the atrium, an amplitude of the intracardial ECG of > or = 1.4 mV was arbitrarily defined as tolerable. At amplitudes of < 1.4 mV, atrial overdrive-stimulation occurred at 400 to 800 ppm in order to convert the AF to sinus rhythm (SR). Following successful overdrive-stimulation, the atrial electrode was positioned according to standard values (P-wave > 3 mV, pacing threshold < 0.5 V at 0.5 ms). In the case of unsuccessful intraoperative atrial stimulation, the electrode was repositioned until an amplitude of > or = 1.4 mV was reached. In all cases bipolar atrial screw electrodes (Model 4068, Medtronic Inc., Minneapolis, MN, USA) were implanted. The intraoperative measurements were carried out via the atrial channel of a 5311 PSA (Medtronic Inc., Minneapolis, MN, USA). In follow-up after 6 weeks, the atrial stimulation threshold was measured in [V] at 0.5 ms and the signal amplitude of the P-wave in [mV], or in the case of AF detection with successful mode switch activation.
In 31/40 patients (77.5 %) with intraoperative persistent AF, fibrillation amplitudes of 1.4 to 3.1 mV (mean value 1.9 +/- 0.4 mV) were measured. In 9/40 patients (22.5 %) with intraoperative AF, 4 cases of conversion to SR using burst stimulation were documented. Atrial lead placement was performed using standard values. After 6 weeks, 33/40 patients (82.5 %) had SR, while intermittent AF episodes with successful mode switch activation were documented in 21 patients (52.5 %). The P-wave amplitude was 3.63 +/- 0.69 mV (range 1.8 to 4.9 mV), the atrial stimulation threshold was 1.3 +/- 0.4 mV (range 0.4 to 1.9 mV). Atrial lead adjustment due to sensing defects was not required for any patients.
The results show that all atrial leads implanted in accordance with this concept demonstrate proper sensing at SR as well as under AF, with successful mode switch episodes and acceptable stimulation thresholds.
评估一种规定的心房导线放置概念在术中房颤（AF）病例中的有效性。
在1998年11月至2000年5月期间，我们对40例房颤患者进行了一项前瞻性研究。将螺旋电极植入心房侧壁后，将心内电图幅度≥1.4 mV任意定义为可耐受。在心内电图幅度<1.4 mV时，以400至800次/分的频率进行心房超速刺激，以将房颤转为窦性心律（SR）。超速刺激成功后，根据标准值（P波>3 mV，起搏阈值在0.5 ms时<0.5 V）放置心房电极。如果术中心房刺激未成功，则重新放置电极，直到达到≥1.4 mV的幅度。所有病例均植入双极心房螺旋电极（型号4068，美敦力公司，美国明尼阿波利斯）。术中测量通过5311 PSA（美敦力公司，美国明尼阿波利斯）的心房通道进行。在6周后的随访中，测量心房刺激阈值（单位：V，脉宽0.5 ms）和P波信号幅度（单位：mV），或者在成功激活模式转换检测到房颤的情况下进行测量。
在31/40例（77.5%）术中持续性房颤患者中，测量到的颤动幅度为1.4至3.1 mV（平均值1.9±0.4 mV）。在9/40例（22.5%）术中房颤患者中，记录到4例通过短阵刺激转为SR。使用标准值进行心房导线放置。6周后，33/40例（82.5%）患者为SR，21例（52.5%）患者记录到伴有成功模式转换激活的间歇性房颤发作。P波幅度为3.63±0.69 mV（范围1.8至4.9 mV），心房刺激阈值为1.3±0.4 mV（范围0.4至1.9 mV）。所有患者均无需因感知缺陷而调整心房导线。
结果表明，按照这一概念植入的所有心房导线在SR以及房颤情况下均显示出适当的感知，伴有成功的模式转换发作和可接受的刺激阈值。
