Jesus I, Pereira S, Camacho A, Leiria G
Serviço de Cardiologia, Hospital Distrital de Faro.
Rev Port Cardiol. 1992 Jul-Aug;11(7-8):655-8.
Two-dimensional echocardiography (2D-ECO) evaluation as an alternative guidance technique during temporary pacing wire placement.
Prospective evaluation of implantation and pacing parameters.
Admission from the Emergency Room and patients studied in the Cardiology Department of the Hospital Distrital in Faro.
Twenty patients with indication for temporary cardiac pacing during, at least, twelve hours (H). Fluoroscopy equipment shouldn't be readily available for implantation.
The mean ages of the 20 pts. (14 men and 6 women) were 71.90 +/- 2.12 years. All pts. had a temporary pacing lead implantation under 2D-ECO guidance. Indications for cardiac pacing were: second or complete atrioventricular block (17 pts.), new onset bifascicular bundle branch block during anterior acute myocardial infarction (1 patient) and sick sinus syndrome (2 pts.). The transvenous route of approach has been the right internal jugular in all the cases and venipuncture time accounts for the calculation of total implantation time.
Ventricular capture was achieved in all pts., with stable stimulation thresholds. The mean implantation time was +/- 9.21 minutes and the mean acute stimulation threshold 0.33 +/- 0.20 V and 0.65 +/- 0.35 mA. The mean voltage of the intracavitary QRS was 11.15 +/- 2.95 mV and the mean lead resistance was 851.33 +/- 194.04 Ohms. The mean utilization time of the pacing leads was 95.15 +/- 87.49 H and the mean stimulation threshold during lead explanation was 0.85 +/- 0.47 mA. The only complication appearing during our study has been one lead dislodgment (5%), 72 h after implantation, placed again with the guidance of 2D-ECO and used during 216 H without further complications. Subcostal 2D-ECO window alone was used in 85% of the pts. but in the remaining (15%), it was insufficient and an apical window was needed too.
The 2D-ECO was an efficient alternative technique of guidance during temporary lead placement, ensuring satisfactory longterm pacing and sensing. Our results indicate that 2D-ECO may be the best alternative control for urgent lead implantation whenever fluoroscopic facilities are remote or logistically not convenient.
评估二维超声心动图（2D-ECO）作为临时起搏导线放置期间的一种替代引导技术。
对植入和起搏参数进行前瞻性评估。
来自急诊室的入院患者以及在法鲁医院区心脏病科接受研究的患者。
20例至少需要临时心脏起搏12小时（H）的患者。植入时无法轻易获得荧光透视设备。
20例患者（14例男性和6例女性）的平均年龄为71.90±2.12岁。所有患者均在2D-ECO引导下植入临时起搏导线。心脏起搏的适应症为：二度或完全性房室传导阻滞（17例）、急性前壁心肌梗死期间新发双分支束支传导阻滞（1例）和病态窦房结综合征（2例）。所有病例均采用经右颈内静脉的经静脉途径，静脉穿刺时间计入总植入时间。
所有患者均实现心室夺获，刺激阈值稳定。平均植入时间为±9.21分钟，平均急性刺激阈值为0.33±0.20V和0.65±0.35mA。腔内QRS波平均电压为11.15±2.95mV，平均导线电阻为851.33±194.04欧姆。起搏导线的平均使用时间为95.15±87.49H，导线拔除期间的平均刺激阈值为0.85±0.47mA。我们研究期间出现的唯一并发症是1例导线脱位（5%），植入后第72小时发生，在2D-ECO引导下再次放置，使用216H无进一步并发症。85%的患者仅使用肋下2D-ECO窗口，但其余患者（15%）该窗口不足，还需要心尖窗口。
2D-ECO是临时导线放置期间一种有效的替代引导技术，可确保长期起搏和感知效果良好。我们的结果表明，每当荧光透视设备距离较远或后勤不便时，2D-ECO可能是紧急导线植入的最佳替代控制方法。
