Lapage Martin J, Rhee Edward K
Washington University School of Medicine, Department of Pediatrics, Division of Pediatric Cardiology, St. Louis, Missouri, USA.
Pacing Clin Electrophysiol. 2008 May;31(5):543-7. doi: 10.1111/j.1540-8159.2008.01038.x.
The potential advantages of using a 4Fr lumenless pacing lead (3830 SelectSecure, Medtronic Inc, Minneapolis, MN, USA) in children are largely negated due to the large size of the delivery system. Here we describe an innovative, sheath guided, delivery technique using conventional 5F sheaths.
Transvenous access was obtained via the left cephalic or axillary vein. A 5Fr introducer set with a 45 degrees curved tip (CheckFlo Performer Introducer Set with the Children's Hospital Boston Modification, Cook Medical Inc, Bloomington, IN, USA) was placed over a wire into the right atrium (RA) or right ventricle (RV). The sheath was modified by cutting off the valved end and a SelectSecuretrade mark lead was introduced through the sheath. Rotating the sheath provided steerability and allowed for precise placement of the lead. After successful lead placement, the sheath was removed with a universal sheath splitter.
We placed seven atrial and six ventricular leads in eight patients during nine separate cases with this method. Patient ages and weights ranged from 5 to 16 years and 16 to -59 kg respectively. Pacing thresholds were excellent at implant. Leads were placed successfully in all attempts. There were no procedural complications. One patient had leads placed twice; both lead systems were removed for suspected infection. Over short-term follow-up in five patients, lead position and characteristics have remained stable.
Delivery of the SelectSecure lead in children can be successfully and precisely performed using a modified 5Fr sheath obviating the need for a large steerable delivery system.
由于输送系统尺寸较大，使用4Fr无腔起搏导线（3830 SelectSecure，美敦力公司，明尼阿波利斯，明尼苏达州，美国）在儿童中的潜在优势在很大程度上被抵消。在此，我们描述一种使用传统5F鞘管的创新的、鞘管引导的输送技术。
经左头静脉或腋静脉获得经静脉通路。将带有45度弯曲尖端的5Fr导入器套件（经波士顿儿童医院改良的CheckFlo Performer导入器套件，库克医疗公司，布卢明顿，印第安纳州，美国）通过导丝置于右心房（RA）或右心室（RV）。通过切断带瓣膜的末端对鞘管进行改良，并将SelectSecure商标导线通过鞘管引入。旋转鞘管可实现可控性，并允许精确放置导线。导线成功放置后，用通用鞘管分离器移除鞘管。
我们用这种方法在9例单独的病例中为8例患者放置了7根心房导线和6根心室导线。患者年龄和体重分别为5至16岁和16至59千克。植入时起搏阈值良好。所有尝试均成功放置导线。无手术并发症。1例患者导线放置了两次；因疑似感染移除了两个导线系统。在5例患者的短期随访中，导线位置和特性保持稳定。
使用改良的5F鞘管可成功且精确地在儿童中输送SelectSecure导线，无需大型可控输送系统。
