Zielińska Marzenna, Kaczmarek Krzysztof, Koniarek Włodzimierz, Goch Jan H
Z Kliniki Kardiologii I Katedry Kardiologii i Kardiochirurgii, Uniwersytetu Medycznego, łodzi.
Wiad Lek. 2006;59(7-8):580-4.
Transvenous pacemaker lead malposition in the left ventricle is a rare complication of pacemaker implantation however, at the moment of diagnosis poses the serious therapeutic problem. The usual morphology for paced events originating from the right ventricle has a left bundle branch block pattern, but sometimes right bundle branch block (RBBB) configuration is identified. The report describes two cases of RBBB configuration in the electrocardiogram (ECG) after pacemaker implantation. Case 1 demonstrates a female with unintentional pacemaker lead placement in the left ventricle through patent foramen ovale. Lead malposition was diagnosed accidentally during echocardiographic study (ECHO), 6 years after implantation. Case 2 concerns a man with a RBBB pacing configuration, but with correct pacemaker lead position in the right ventricle. Authors analyze these cases in connection with other publicized reports in order to find the safe algorithm for intraoperative estimation of correct pacemaker lead location. The following algorithm of procedures during pacemaker implantation is proposed to avoid the lead malposition in the left ventricle. First, obligatory perform 12-lead ECG in pace mode during surgery or immediately after it. Second, in case of RBBB pattern in post implant ECG, make ECHO for precise lead position description.
经静脉起搏器导线误置于左心室是起搏器植入术罕见的并发症，然而，在诊断时会带来严重的治疗问题。源自右心室的起搏事件通常形态呈左束支传导阻滞图形，但有时也会识别出右束支传导阻滞（RBBB）图形。本报告描述了两例起搏器植入术后心电图（ECG）呈现RBBB图形的病例。病例1为一名女性，起搏器导线通过卵圆孔未闭意外置入左心室。植入6年后，在超声心动图检查（ECHO）期间偶然诊断出导线位置异常。病例2涉及一名男性，其起搏图形为RBBB，但起搏器导线在右心室位置正确。作者结合其他已发表的报告对这些病例进行分析，以找到术中评估起搏器导线正确位置的安全方法。为避免起搏器导线误置于左心室，建议在起搏器植入过程中采用以下操作流程。首先，术中或术后立即在起搏模式下进行12导联心电图检查。其次，若植入后心电图呈现RBBB图形，进行超声心动图检查以精确描述导线位置。
