Jereczek M, Levenson B
Abteilung Kardiologie und Pulmologie, Klinikum Steglitz der Freien, Universität Berlin.
Z Kardiol. 1992 Sep;81(9):492-5.
Ten years after mitral-valve replacement, a 69-year-old patient underwent VVI pacemaker implantation because of symptomatic bradyarrhythmia. Postoperatively, the electrocardiogram showed a right bundle branch pattern under ventricular stimulation while the threshold was optimal. Under fluoroscopy, we suspected a malposition of the electrode outside the right ventricle in the LAO and lateral view. This could not be verified by echocardiography, whereas contrast angiography of the right ventricle proved the extracavitary position of the electrode under the inferior wall of the left ventricle, probably in the middle cardiac vein. The electrode position was operatively corrected without complications. We discuss different ways of malposition and their detection by considering electrocardiographic configuration and fluoroscopy in LAO and lateral view.
二尖瓣置换术后十年，一名69岁患者因症状性缓慢性心律失常接受了VVI起搏器植入术。术后，心电图显示心室刺激时呈右束支图形，且阈值最佳。在荧光透视下，在左前斜位和侧位视图中，我们怀疑电极在右心室外部位置不当。超声心动图无法证实这一点，而右心室造影显示电极位于左心室下壁下方的心腔外位置，可能在心中静脉内。电极位置通过手术得到纠正，无并发症发生。我们通过考虑心电图形态以及左前斜位和侧位视图中的荧光透视，讨论了电极位置不当的不同方式及其检测方法。
